Significance of hyperintense vessels on FLAIR MRI in acute stroke

Kamran, Saadat; Bates, Vernice; Bakshi, Rohit; Wright, Peter; Kinkel, William R.; Miletich, Robert S.

doi:10.1212/wnl.55.2.265

Cited by 127 publications

(148 citation statements)

References 12 publications

(19 reference statements)

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“…Others have related the phenomenon to alterations in blood flow. 4,7,9 When FLAIR images were compared with catheter angiograms obtained in Ͻ6 hours of the MR imaging acquisition, FVHs were noted in areas of retrograde leptomeningeal collateral flow and just proximal to large-vessel occlusion. 9 Further evidence for FVH representing impaired hemodynamics and retrograde collateral blood flow includes its presence in acute stroke, due to large-vessel stenosis 8 or occlusion, 12 its transient nature, 9,12 and the fact that it was not seen in the hemisphere contralateral to cerebral ischemia.…”

Section: Pathophysiology Resulting In Fvhmentioning

confidence: 99%

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Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Azizyan

Sanossian²,

Mogensen³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:Vascular hyperintensities have been noted on FLAIR sequences obtained in the setting of acute stroke and intracranial steno-occlusive disease. The presence of FVHs likely represents disordered blood flow, often from collaterals distal to arterial occlusion or stenosis. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus, but rather sluggish or disordered blood flow through vessels. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making.ABBREVIATIONS: DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FVH ϭ FLAIR vascular hyperintensity; GRE-BA ϭ gradient-echo susceptibility vessel blooming artifacts; HMCAS ϭ hyperdense MCA sign seen on CT; HVS ϭ hyperintense vessel sign; MCA ϭ middle cerebral artery; MRA ϭ MR angiography; MRI ϭ MR imaging; NIHSS ϭ National Institutes of Health Stroke Scale; PWI ϭ perfusion-weighted imaging; rtPA ϭ recombinant tissue plasminogen activator; TOF ϭ time of flight; TIA ϭ transient ischemic attacks A dvances in MR imaging have allowed better characterization of tissue and vessel status in cerebrovascular diseases, including acute stroke. Although the particular MR imaging sequences used for evaluation of stroke vary among institutions, FLAIR sequences are usually obtained. FLAIR sequences have a high sensitivity and specificity for the evaluation of brain parenchyma pathology and the subarachnoid spaces. 1,2One frequently encountered imaging finding in acute ischemic stroke is high signal intensity within blood vessels on FLAIR sequences (Fig 1). We aimed to review the current understanding of the etiology, physiology, and clinical significance of FVH. This underappreciated neuroimaging sign may have important clinical implications.In the past decade, FVHs have been associated with largevessel occlusion 3-7 or stenosis. 8 This finding has been termed "FVH," "hyperintense vessel sign," "hyperintense vessels on FLAIR," and the "ivy sign" (Table). For this review, it will be referred to exclusively as FVH. FVHs are described as focal, tubular, or serpentine hyperintensities seen, often transiently, in the subarachnoid space against the relative hypointensity of CSF. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus but rather is a representation of the sluggish or disordered blood flow through vessels, most often leptomeningeal collaterals.9,10 Its presence indicates regions of abnormal blood flow and potentially salvageable brain tissue in acute stroke. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making. Identification of FVHThe key to identification of FVH is to be aware of its appearance and of the clinical conditions in which it appears with greater frequency. Although the most frequent location is within the Sylvian fissure, FVH has been noted within distal branches of the anterior, middle, and posteri...

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Section: Pathophysiology Resulting In Fvhmentioning

confidence: 99%

“…In the past decade, FVHs have been associated with largevessel occlusion [3][4][5][6][7] or stenosis. 8 This finding has been termed "FVH," "hyperintense vessel sign," "hyperintense vessels on FLAIR," and the "ivy sign" (Table).…”

mentioning

confidence: 99%

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Azizyan

Sanossian²,

Mogensen³

et al. 2010

AJNR Am J Neuroradiol

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“…In hyperacute stroke patients with occlusion of a major intracerebral artery, sufficient data are available to suggest that HVS on FLAIR represent altered hemodynamics. 9,10,17 Indeed, HVS in acute stroke has been shown to correlate not only with slow anterograde and leptomeningeal collateral arterial flow on DSA 9 but also with intravascular enhancement on T1-weighted pulse sequence, 9 regional hypoperfusion, 9,17 and larger infarct volume. 8 -10,17 These data support the hypothesis that HVS is the result of an arterial slow-flow phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…8 -10,17 These data support the hypothesis that HVS is the result of an arterial slow-flow phenomenon. 9 In patients with multiple arterial stenoses, HVS could correspond to hemodynamic changes distally to arterial stenoses. Alternatively, it could be a direct picture of the stenosis itself.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several groups have reported an increased intensity in cerebral blood vessels on FLAIR in the setting of acute ischemia in patients with major vessel occlusion or severe stenosis. 8,9 This so-called hyperintense vessel sign (HVS) on FLAIR MRI is thought to indicate the presence of slow flow or stasis in small arteries, veins, and collateral vessels. 10 We hypothesized that HVSs could be associated with the presence of multiple intracerebral arterial stenoses regardless of the presence of a brain infarct.…”

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confidence: 99%

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Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses

Iancu

Oppenheim

Touzé

et al. 2003

Stroke

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Background and Purpose-Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) has been described in hyperacute stroke patients with arterial occlusion. We sought to determine whether HVS was more frequent in patients with intracerebral arterial stenoses than in those without stenosis regardless of the presence of a brain infarct. Methods-In this case-control study (19 symptomatic patients with multiple intracerebral arterial stenoses compared with 19 age-matched asymptomatic patients without stenosis), we looked for HVS (ie, focal or tubular hyperintensities in the subarachnoid space) on FLAIR images. We compared the proportion of HVS-positive patients in the 2 groups and evaluated the concordance between the arterial distribution of stenoses on angiogram and that of HVS on FLAIR. Results-HVS was found in 13 of 19 patients (68%) in the study group and 1 of 19 control patients (5.2%) (PϽ0.0001).The concordance between the territorial distribution of stenoses on angiogram and HVS on FLAIR was higher for the right and left middle cerebral artery (ϭ0.6 and 0.63, respectively) compared with the right and left anterior cerebral artery (ϭ0.35 and 0.2, respectively). HVSs were observed in 1 of 7 patients with posterior cerebral artery stenoses on angiogram. HVSs were seen equally in patients with acute focal (7 of 10) or diffuse (6 of 9) cerebral involvement. In the 6 HVS-positive patients with acute stroke confirmed by MRI, additional HVSs were observed in a different arterial territory than that of the stroke lesion.

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Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Detects Cortical and Juxtacortical Multiple Sclerosis Lesions

Bakshi

Ariyaratana²,

Benedict³

et al. 2001

Arch Neurol

180

119

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Significance of hyperintense vessels on FLAIR MRI in acute stroke

Cited by 127 publications

References 12 publications

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses

Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Detects Cortical and Juxtacortical Multiple Sclerosis Lesions

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