Prognostic Value of Hyperintense Vessel Signals on Fluid-Attenuated Inversion Recovery Sequences in Acute Cerebral Ischemia

Abstract

Background: Fluid-attenuated inversion recovery (FLAIR) sequences may reveal hyperintense vessel signals (HVS) at the acute stage of cerebral ischemia. The aim of this study was to test the hypothesis that HVS are associated with a worse outcome. Methods: We included 30 consecutive patients admitted within 12 h after onset of hemispheric cerebral ischemia. The outcome was assessed with the modified Rankin Scale at month 1. Results: Proximal HVS were present in 9 patients and distal HVS in 16. All patients with proximal occlusions on time-of-flight sequences had distal HVS on FLAIR. Patients with poor outcome at month 1 (modified Rankin Scale 3–6) more frequently had had HVS on MRI (12/13 vs. 4/17; p< 0.001). Conclusion: Distal HVS found on FLAIR sequences within 12 h of acute cerebral ischemia are associated with a worse 1-month outcome.

Fluid-Attenuated Inversion Recovery Images and Stroke Outcome After Thrombolysis

“…4,8 It has been suggested as an indicator of both collateral blood flow and bad outcome after 1 month. 5,9 FHA may be testimony for impaired hemodynamics and insufficient collaterals. 3 Conflicting findings from previous studies may be partly attributable to differing methodologies.…”

“…They have been interpreted as an indicator of slow blood flow, inadequate collateral circulation, and poor outcome. [3][4][5] Others found no independent association of hyperintense vessels with clinical outcomes. 6 The ischemic cascade is an intricate process involving complex hemodynamics and a series of biochemical reactions on a cellular level.…”

Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease

“…Willis have failed, the presence of secondary collateral pathways is possibly considered a marker for impaired cerebral hemodynamics. 16,17 Furthermore, an ivy sign on FLAIR can be observed in patients with chronic vascular diseases. Two recent studies, 1 of which includes the study reported by our group, revealed that the existence of an ivy sign on a FLAIR image in patients with Moyamoya disease is associated with decreased cerebral VR and development of leptomeningeal collaterals.…”

Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

“…1 Several studies suggest FHV to be indicative of hemodynamic stress, inadequate collateralization, and poor functional recovery. [2][3][4][5] Conversely, others attributed FHV to increased leptomeningeal collateralization and found an association with smaller lesions, slower infarct progression, and better prognosis. [6][7][8][9][10] The apparent contradiction of these studies may stem from the use of different methodologies and the diversity of populations studied, making the plethora of results challenging to analyze.…”