Hyperintense Vessels on Acute Stroke Fluid-Attenuated Inversion Recovery Imaging

Abstract

Background and Purpose—: Hyperintense vessels (HVs) have been observed in fluid-attenuated inversion recovery imaging of patients with acute ischemic stroke and been linked to slow flow in collateral arterial circulation. Given the potential importance of HV, we used a large, multicenter data set of patients with stroke to clarify which clinical and imaging factors play a role in HV. Methods—: We analyzed data of 516 patients from the previously published PRE-FLAIR study ( PRE dictive value of FLAIR and DWI for the identification of acute ischemic stroke patients ≤3 and ≤4.5 hours of symptom onset—a multicenter study) study. Patients were studied by MRI within 12 hours of symptom onset. HV were defined as hyperintensities in fluid-attenuated inversion recovery corresponding to the typical course of a blood vessel that was not considered the proximal, occluded main artery ipsilateral to the diffusion restriction. Presence of HV was rated by 2 observers and related to clinical and imaging findings. Results—: Presence of HV was identified in 240 of all 516 patients (47%). Patients with HV showed larger initial ischemic lesion volumes (median, 12.3 versus 4.9mL; P P P <0.001). HV detected vessel occlusion with a specificity of 0.86 (95% CI, 0.80–0.90) and sensitivity of 0.76 (95% CI, 0.69–0.83). Conclusions—: HVs are a common finding associated with proximal arterial occlusions and more severe strokes. HVs predict arterial occlusion with high diagnostic accuracy.