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FLAIR distal hyperintense vessels as a marker of perfusion-diffusion mismatch in acute stroke
Diogo C Haussen1, Sebastian Koch, Efrat Saraf-Lavi
1Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Neurology, Miami, FL, USA.
Background And Purpose:
Distal hyperintense vessels (DHV) on MRI FLAIR sequences in acute brain ischemia are thought to represent leptomeningeal collateral flow. We hypothesized that DHV are more common in acute stroke patients with perfusion-diffusion weighted mismatch (PDM) than in those without.
Methods:
We performed a retrospective study of consecutive anterior circulation stroke patients who underwent multimodal MRI within 8 hours of onset. We correlated DHV occurrence with the presence or absence of PDM, and analyzed DHV correlates when angiography was available.
Results:
Twenty-one patients with PDM and 28 without were included. On univariate analysis, there was no significant difference regarding demographic variables between the two groups, with the exception of a higher frequency of atrial fibrillation (33% vs. 7%; P = .02) and intravenous tissue plasminogen activator use (57% vs 25%; P = .03) in the PDM patients. The PDM group more commonly had DHV (85% vs 25%; P < .001). On multivariate analysis, DHV presence (odds ratio, 6.01; 95% confidence-interval, 1.08-33.29; P = .04) and vessel occlusion site (odds ratio, 3.17; 95% confidence-interval, 1.21-8.31; P = .01) were the only variables independently associated with PDM. Conventional angiography was useful correlating DHV presence and collateral flow in a subset of patients.
Conclusions:
DHV may be a surrogate marker for PDM in patients with hyperacute ischemic stroke.
Insights
Distal hyperintense vessels (DHV) on MRI are more common in acute stroke patients with perfusion-diffusion mismatch (PDM). DHV may indicate leptomeningeal collateral flow and serve as a marker for PDM in hyperacute ischemic stroke.
Area of Science:
- Neuroradiology
- Cerebrovascular Imaging
- Acute Stroke Imaging
Background:
- Distal hyperintense vessels (DHV) on MRI FLAIR sequences are indicators of leptomeningeal collateral flow in acute brain ischemia.
- The association between DHV and perfusion-diffusion weighted mismatch (PDM) in acute stroke remains to be fully elucidated.
Purpose of the Study:
- To investigate the hypothesis that DHV are more prevalent in acute stroke patients exhibiting PDM compared to those without.
- To establish DHV as a potential imaging biomarker for PDM in hyperacute ischemic stroke.
Main Methods:
- Retrospective analysis of anterior circulation stroke patients undergoing multimodal MRI within 8 hours of symptom onset.
- Correlation of DHV presence with PDM status and analysis of DHV correlates using conventional angiography when available.
Main Results:
- Patients with PDM showed a significantly higher incidence of DHV (85%) compared to those without PDM (25%).
- Multivariate analysis identified DHV presence (OR, 6.01) and vessel occlusion site (OR, 3.17) as independent predictors of PDM.
- Conventional angiography confirmed the correlation between DHV and collateral flow in a subset of patients.
Conclusions:
- DHV on MRI FLAIR sequences may serve as a valuable surrogate marker for identifying PDM in hyperacute ischemic stroke patients.
- This finding aids in the rapid assessment of hemodynamic compromise and potential for reperfusion therapies.
