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FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome

  • Liang Jiang
  • Yu-Chen Chen
  • Hong Zhang
  • Mingyang Peng
  • Huiyou Chen
  • Wen Geng
  • Quan Xu
  • Xindao YinEmail author
  • Yuehu MaEmail author
Head and Neck

Abstract

Purpose

Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently found in stroke patients after intracranial arterial occlusion, but the prognostic value of FVH findings is unclear. We assessed whether FVH is associated with cerebral collateral status and functional outcome in patients with acute stroke patients receiving endovascular therapy.

Methods

FVH score, American Society of Interventional and Therapeutic Neuroradiology (ASITN) grade, the functional outcome at 3 months (modified Rankin Scale (mRS)), and other clinical data were collected for 37 acute stroke patients with large vessel occlusion (LVO) receiving MRI before and after endovascular therapy. Statistical analysis was performed to predict functional outcome after stroke.

Results

The good functional outcome group (n = 16) had a higher FVH1 (FVH before therapy) score (4.63 ± 1.20 vs 3.14 ± 1.15; p = 0.001) and ASITN grade (3.31 ± 0.48 vs 2.00 ± 1.22; p < 0.001) and a lower FVH2 (FVH after therapy) score than the poor functional outcome group (n = 21; 0.125 ± 0.50 vs 1.44 ± 2.16; p = 0.030). mRS at 3 months was negatively correlated with FVH1 (r = − 0.525, p = 0.001) and the ASITN grade (r = − 0.478, p = 0.003) and positively correlated with FVH2 (r = 0.376, p = 0.034). FVH1 (OR, 0.085; 95% CI, 0.013–0.577; p = 0.012) and FVH2 (OR, 2.724; 95% CI, 1.061–6.996; p = 0.037) were independently associated with functional outcome in multivariable logistic regression analysis.

Conclusions

Assessing FVH before and after therapy in acute stroke patients with LVO might be useful for predicting functional outcome after stroke.

Key Points

• Fluid-attenuated inversion recovery vascular hyperintensity is a circular or serpentine brightening in the brain parenchyma or cortical surface bordering the subarachnoid space on MR imaging.

• A prospective study showed that fluid-attenuated inversion recovery vascular hyperintensity is associated with cerebral collateral circulation and prognosis.

• Fluid-attenuated inversion recovery vascular hyperintensity helps clinicians to predict the prognosis of patients with acute stroke.

Keywords

Stroke Magnetic resonance imaging Angiography Collateral circulation Prognosis 

Abbreviations

ASITN

American Society of Interventional and Therapeutic Neuroradiology

ASPECTS

Alberta Stroke Program Early CT Score

CI

Confidence interval

CTA

Computed tomography angiography

DSA

Digital subtraction angiography

DWI

Diffusion-weighted imaging

FLAIR

Fluid-attenuated inversion recovery

FVH

Fluid-attenuated inversion recovery vascular hyperintensity

LVO

Large vessel occlusion

MRA

Magnetic resonance angiography

MRI

Magnetic resonance imaging

mRS

Modified Rankin Scale

mTICI

Modified Thrombolysis in Cerebral Ischemia

NIHSS

National Institutes of Health Stroke Scale

Notes

Authors’ contribution

LJ and Y-C C designed the experiment, collected the data, performed the analysis, and wrote the paper. HZ, MP, HC, WG, and QX helped collect the data and perform the analysis. XY and YM contributed to the discussion and manuscript revision.

Funding

This study has received funding by Jiangsu Provincial Special Program of Medical Science (No. BE2017614).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Xindao Yin.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

All patients in this study have written informed consent before examined.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Liang Jiang
    • 1
  • Yu-Chen Chen
    • 1
  • Hong Zhang
    • 2
  • Mingyang Peng
    • 1
  • Huiyou Chen
    • 1
  • Wen Geng
    • 1
  • Quan Xu
    • 1
  • Xindao Yin
    • 1
    Email author
  • Yuehu Ma
    • 1
    Email author
  1. 1.Department of Radiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
  2. 2.Department of RadiologyThe Affiliated Jiangning Hospital of Nanjing Medical UniversityNanjingChina

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