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FLAIR vascular hyperintensities in acute ICA and MCA infarction: a marker for mismatch and stroke severity?

M Hohenhaus1, W U Schmidt, P Brunecker

  • 1Center for Stroke Research Berlin and Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.

Cerebrovascular Diseases (Basel, Switzerland)
|July 5, 2012
PubMed
Abstract

Insights

FLAIR vascular hyperintensities (FVH) on stroke MRI indicate larger ischemic areas and more severe strokes in patients with anterior circulation occlusion. A high FVH count may predict initial ischemic mismatch and stroke severity.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Imaging

Background:

  • FLAIR vascular hyperintensities (FVH) on stroke MRI are common, reflecting slow flow or stasis in brain arteries.
  • FVH are proposed as a marker for cerebral hypoperfusion, but their impact on infarct size and clinical outcomes in acute stroke is debated.
  • This study investigates the association of FVH with infarct morphology, severity, and growth in patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.

Purpose of the Study:

  • To evaluate the association between FLAIR vascular hyperintensities (FVH) and infarct characteristics in acute stroke patients.
  • To determine if FVH correlate with infarct size, morphology, and clinical severity in symptomatic ICA or MCA occlusion.
  • To assess FVH as a potential marker for initial ischemic mismatch and stroke progression.

Main Methods:

  • Retrospective review of MR images from 84 acute stroke patients with symptomatic ICA or MCA occlusion/stenosis.
  • Assessment of vessel occlusion using MRA, grading with TIMI score, and evaluation of diffusion-perfusion deficits and FLAIR lesion volumes.
  • Quantification of FVH presence and number, analyzed for associations with infarct volumes, morphology, recanalization, white matter disease, hemorrhagic transformation, stroke severity (NIHSS), etiology, and thrombolysis rates.

Main Results:

  • FVH were detected in 89.3% of patients, with a median count of 4.
  • Patients with >4 FVH had significantly higher NIHSS scores, larger initial DWI lesions, perfusion deficits, and mismatch volumes/ratios.
  • A higher FVH count was associated with larger final infarct volumes and increased frequency of hemorrhagic transformation.

Conclusions:

  • The presence of FVH is indicative of larger ischemic brain areas, primarily in proximal anterior circulation occlusions.
  • A high number of FVH may serve as a surrogate marker for initial ischemic mismatch and stroke severity.
  • FVH assessment on FLAIR MRI can provide valuable prognostic information in acute stroke management.

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