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

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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.

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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

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Funding

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

Author information

Author notes

  1. Liang Jiang and Yu-Chen Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China

    Liang Jiang, Yu-Chen Chen, Mingyang Peng, Huiyou Chen, Wen Geng, Quan Xu, Xindao Yin & Yuehu Ma

  2. Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China

    Hong Zhang

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  1. Liang Jiang
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Contributions

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.

Corresponding authors

Correspondence to Xindao Yin or Yuehu Ma.

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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.

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Institutional Review Board approval was obtained.

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• prospective

• diagnostic or prognostic study

• performed at one institution

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Jiang, L., Chen, YC., Zhang, H. et al. FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome. Eur Radiol 29, 4879–4888 (2019). https://doi.org/10.1007/s00330-019-06022-0

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  • DOI: https://doi.org/10.1007/s00330-019-06022-0

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