Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus
Open Access
- 20 November 2008
- journal article
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 30 (3), 564-568
- https://doi.org/10.3174/ajnr.a1388
Abstract
BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are commonly encountered on MR imaging studies performed shortly after the onset of acute ischemic stroke. Prior reports have speculated regarding the pathogenesis of this finding, yet definitive correlative angiographic studies have not been performed. We studied the pathophysiologic and hemodynamic correlates of FVH on conventional angiography and concurrent MR imaging sequences. MATERIALS AND METHODS: Retrospective review of FLAIR and gradient-refocused echo MR imaging sequences acquired immediately before conventional angiography for acute stroke was conducted in a blinded fashion. The presence, location, and morphology of FVH were noted and correlated with markers of thrombotic occlusion and collateral flow on angiography. Angiographic collaterals were graded on a 5-point scale incorporating extent and hemodynamic aspects. RESULTS: A prospective ischemic stroke registry of 632 patients was searched to identify 74 patients (mean age, 63.4 ± 20 years; 48% women) having undergone FLAIR sequences immediately before angiography. Median time from FLAIR to angiography was 2.9 hours (interquartile range, 1.1–4.7 hours). FVH were present in 53/74 (72%) of all acute stroke cases with subsequent angiography. FVH distal to an arterial occlusion were associated with a high grade of leptomeningeal collateral blood flow. CONCLUSIONS: FVH are observed in areas of blood flow proximal and distal to stenosis or occlusion and are noted with more extensive collateral circulation.Keywords
This publication has 15 references indexed in Scilit:
- FLAIR vascular hyperintensity may predict stroke after TIAClinical Neurology and Neurosurgery, 2007
- Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparisonThe Lancet, 2007
- Collaterals in Acute Stroke: Beyond the ClotNeuroimaging Clinics of North America, 2005
- Guidelines for the Early Management of Patients With Ischemic StrokeStroke, 2005
- Diagnostic and Prognostic Value of Early MR Imaging Vessel Signs in Hyperacute Stroke Patients Imaged <3 Hours and Treated with Recombinant Tissue Plasminogen Activator2005
- Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic StrokeStroke, 2003
- Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial StenosesStroke, 2003
- Mechanism of Bradykinin-Induced Ca2+ Mobilization in MG63 Human Osteosarcoma CellsHormone Research in Paediatrics, 2001
- Fluid-attenuated Inversion Recovery Intraarterial Signal: An Early Sign of Hyperacute Cerebral Ischemia2001
- Acute subarachnoid hemorrhage: MR imaging with fluid-attenuated inversion recovery pulse sequences.Radiology, 1995