FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy

Lyu, Jinhao; Zhang, Sen-hao; Wang, Xueyang; Meng, Zhihua; Wu, Xiaoyan; Chen, Wen; Wang, Guohua; Niu, Qingliang; Li, Xin; Bian, Yitong; Han, Dan; Guo, Weiting; Yang, Shuai; Wei, Meng-ting; Zhang, Ting-yang; Duan, Qi; Duan, Caohui; Bian, Xiaowei; Tian, Chenglin; Lou, Xin

doi:10.1007/s00330-022-08661-2

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…Blood flow is delayed and atrial transit time is prolonged in the downstream of the stenotic or occlusive artery. 23,24 The volume of hypoperfusion for longer PLD indicates a territory with more severely delayed blood flow. [25][26][27] The previously proposed thresholds to define the penumbra were derived from the CBF map using ASL with a PLD of 2.000 msec.…”

Section: Discussionmentioning

confidence: 99%

“…One major reason for this might be that CBF did not reach its peak in patients with large vessel occlusion (LVO). Blood flow is delayed and atrial transit time is prolonged in the downstream of the stenotic or occlusive artery 23,24 . The volume of hypoperfusion for longer PLD indicates a territory with more severely delayed blood flow 25–27 .…”

Section: Discussionmentioning

confidence: 99%

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Arterial Spin Labeling‐Based MRI Estimation of Penumbral Tissue in Acute Ischemic Stroke

Lyu

Duan

Xiao

et al. 2022

Magnetic Resonance Imaging

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Background: Arterial spin labeling (ASL) has shown potential for the assessment of penumbral tissue in patients with acute ischemic stroke (AIS). The postlabeling delay (PLD) parameter is sensitive to arterial transit delays and influences cerebral blood flow measurements. Purpose: To assess the impact of ASL acquisition at different PLDs for penumbral tissue quantification and to compare their performance regarding assisting patient selection for endovascular treatment with dynamic susceptibility contrast MRI (DSC-MRI) as the reference method. Study Type: Retrospective. Population: A total of 53 patients (59.98 AE 12.60 years, 32% women) with AIS caused by internal carotid or middle cerebral artery occlusion. Field Strength/Sequence: A 3-T, three-dimensional pseudo-continuous ASL with fast-spin echo readout. Assessment: Hypoperfusion volume was measured using DSC-MRI and ASL with PLDs of 1.500 msec and 2.500 msec, respectively. Eligibility for endovascular treatment was retrospectively determined according to the imaging criteria of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke trial (DEFUSE 3). Statistical Tests: Kruskal-Wallis tests, Bland-Altman plots, Cohen's kappa, and receiver operating characteristic analyses were used. The threshold for statistical significance was set at P < 0.05. Results: Hypoperfusion volume for ASL with a PLD of 1.500 msec was significantly larger than that for DSC-MRI, while the hypoperfusion volume for a PLD of 2.500 msec was not significantly different from that of DSC-MRI (P = 0.435). Bland-Altman plots showed that the mean volumetric error between the hypoperfusion volume measured by DSC-MRI and ASL with PLDs of 1.500/2.500 msec was À107.0 mL vs. 4.49 mL. Cohen's kappa was 0.679 vs. 0.773 for DSC-MRI and ASL, respectively, with a PLD of 1.500/2.500 msec. The sensitivity and specificity for ASL with a PLD of 1.500/2.500 msec in

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arterial Spin Labeling‐Based MRI Estimation of Penumbral Tissue in Acute Ischemic Stroke

Lyu

Duan

Xiao

et al. 2022

Magnetic Resonance Imaging

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“…15 16 More importantly, studies have shown that the prominence and location of FVH may correlate with collateral circulation as well as the severity of haemodynamic impairments, and further impact clinical outcomes in acute ischaemic stroke. [17][18][19][20] In patients with transient ischaemic attack (TIA), the presence of FVH has been proven to be a marker of stroke. 21 These studies highlight the predictive value of FVH in the acute stage of cerebral ischaemia.…”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

“…Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), an imaging sign of the absence of arterial flow voids on T2-FLAIR, is believed to be a feasible imaging marker for identifying patients with cerebral artery steno-occlusion 15 16. More importantly, studies have shown that the prominence and location of FVH may correlate with collateral circulation as well as the severity of haemodynamic impairments, and further impact clinical outcomes in acute ischaemic stroke 17–20. In patients with transient ischaemic attack (TIA), the presence of FVH has been proven to be a marker of stroke 21.…”

Section: Introductionmentioning

confidence: 99%

Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion

Lyu

Wang

et al. 2022

Stroke Vasc Neurol

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Background and purposeIndividuals with intracranial artery occlusion have high rates of ischaemic events and recurrence. It has been challenging to identify patients who had high-risk stroke using a simple, valid and non-invasive screening approach. This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), a specific imaging sign on the FLAIR sequence, could be a predictor of ischaemic events in a population with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.MethodsWe retrospectively analysed 147 patients (mean 60.43±12.83 years) with 149 lesions, including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion. Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days. FVH Alberta Stroke Program Early Computed Tomography Score (FVH-ASPECTS: 0–7, with 0 indicating absence of FVH and 7 suggesting prominent FVH) and collateral circulation grade were assessed for each participant. Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status.ResultsA lower FVH-ASPECTS was associated with a more favourable collateral circulation grade (rho=−0.464, p<0.0001). The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group (p<0.0001). FVH-ASPECTS (Odd ratio, 2.973; 95% confidence interval, 1.849 to 4.781; p<0.0001) was independently associated with symptomatic status after adjustment for age, sex, lesion location and collateral circulation grade in the multivariate logistic regression. The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion.ConclusionsThe ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke. As a simple imaging sign, FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.

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“…with 5 years of experience), blinded to the collateral grade. This rating allowed us to compute FVH ASPECTS ranging from 0 (no FVH) to 7 (FVH abutting all cortical ASPECTS regions) 26,27 and FVH-DWI mismatch ASPECTS ranging from 0 (no FVH-DWI mismatch) to 7 (FVH-DWI mismatch in all cortical ASPECTS areas). 12 To assess reproducibility, an experienced neuroradiologist (L.L.…”

Section: Pwi Collateral Flow Map Generation and Gradingmentioning

confidence: 99%

FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters

Legrand¹,

Berre²,

Seners³

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS:We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS:Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P ¼ .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P , .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P , .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P , .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P ¼ .02). CONCLUSIONS:In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

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FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy

Cited by 6 publications

References 34 publications

Arterial Spin Labeling‐Based MRI Estimation of Penumbral Tissue in Acute Ischemic Stroke

Arterial Spin Labeling‐Based MRI Estimation of Penumbral Tissue in Acute Ischemic Stroke

Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion

FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters

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