The hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery images can frequently be detected in patients with acute cerebral infarction attributable to large artery stenosis or occlusion. The prognostic values and clinical characteristics of HVS remain to be elucidated. The aim of this study was to evaluate the association of HVS with ischemic lesions and severity of neurologic deficit.
A total of 96 consecutive acute ischemic stroke patients (54 women, median age 76.5 [range 39-97] years), who had symptomatic severe stenosis or occlusion in the proximal middle cerebral artery that was detected with magnetic resonance angiography within 24 hours of onset, were enrolled. The extent of HVS was graded by a systematic quantitative scoring system (the HVS distribution score) based on Alberta Stroke Program Early Computed Tomographic Score.
An HVS was detected in 89 patients (93%) at admission, and the patients who displayed wider HVS distribution scores exhibited more severe neurologic deficits at admission (P < .05). The follow-up magnetic resonance imaging, which was obtained in 79 patients (82%), was performed an average of 13 days. The association between HVS distribution score and final ischemic lesions was strongly observed (n = 67, P < .05) but not in the patients with intravenous thrombolysis (n = 12, P = .06).
Although the distribution of HVS reflected final ischemic lesion, this association might not apply to the patients with the thrombolysis treatment. The interpretation of HVS distribution score with acute ischemic stroke patients should be discussed dependent on thrombolysis.
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- Fast FLAIR sequence for detecting major vascular abnormalities during the hyperacute phase of stroke: a comparison with MR angiography.Neuroradiology. 1999; 41: 342-346
- Significance of hyperintense vessels on FLAIR MRI in acute stroke.Neurology. 2000; 55: 265-269
- Arterial hyperintensity on fast fluid-attenuated inversion recovery images: a subtle finding for hyperacute stroke undetected by diffusion-weighted MR imaging.AJNR Am J Neuroradiol. 2001; 22: 632-636
- Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia.AJNR Am J Neuroradiol. 2001; 22: 1021-1029
- Significance of hyperintense vessels on FLAIR MRI in acute stroke.Neurology. 2001; 56: 1248-1249
- Evaluation of hyperintense vessels on FLAIR MRI for the diagnosis of multiple intracerebral arterial stenoses.Stroke. 2003; 34: 1886-1891
- Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus.AJNR Am J Neuroradiol. 2009; 30: 564-568
- Prognostic value of hyperintense vessel signals on fluid-attenuated inversion recovery sequences in acute cerebral ischemia.Eur Neurol. 2007; 57: 75-79
- Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke?.Neurology. 2009; 72: 1134-1139
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment.Stroke. 1993; 24: 35-41
- Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.J Neurol Neurosurgery Psychiatry. 2005; 76: 1528-1533
- FLAIR vascular hyperintensities in acute ICA and MCA infarction: a marker for mismatch and stroke severity?.Cerebrovasc Dis. 2012; 34: 63-69
- Hyperintense vessels on FLAIR: a useful non-invasive method for assessing intracerebral collaterals.Eur J Radiol. 2011; 80: 786-791
- Distal hyperintense vessels on flair images predict large-artery stenosis in patients with transient ischemic attack.Neuroradiology. 2013; 55: 165-169
- Clinical significance of fluid-attenuated inversion recovery vascular hyperintensities in transient ischemic attack.Stroke. 2013; 44: 1635-1640
Published online: January 13, 2014
Accepted: November 11, 2013
Received in revised form: November 11, 2013
Received: October 9, 2013
Conflict of interest: All authors declared no conflict of interest.
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.