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Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion
E Mahdjoub1, G Turc2, L Legrand1
1From the Departments of Radiology (E.M., L.L., J.B., M.E., S.C., W.B.H., O.N., J.-F.M., C.O.).
AJNR. American Journal of Neuroradiology
|October 28, 2017
Summary
Extensive FLAIR hyperintensities in acute ischemic stroke indicate good collaterals, aiding reperfusion therapy decisions. This finding helps identify patients likely to benefit from treatment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- The role of FLAIR hyperintensities in acute ischemic stroke as indicators of collateral status is debated.
- FLAIR vascular hyperintensities may represent good collaterals, indirectly assessed by hypoperfusion intensity ratio.
Purpose of the Study:
- To investigate the association between the extent of FLAIR vascular hyperintensities and collateral status in acute ischemic stroke.
- To determine if FLAIR hyperintensities can predict good collaterals, assessed by hypoperfusion intensity ratio.
Main Methods:
- 244 patients with MCA stroke undergoing reperfusion therapy and pretreatment MRI (FLAIR, PWI) were analyzed.
- FLAIR vascular hyperintensity score (0-7) based on ASPECTS; hypoperfusion intensity ratio calculated from PWI.
- Patients dichotomized into good (low ratio) and poor (high ratio) collaterals based on median hypoperfusion intensity ratio.
Main Results:
- All patients exhibited hypoperfusion; median hypoperfusion intensity ratio was 0.35.
- FLAIR hyperintensities were more extensive in patients with good collaterals (ratio ≤0.35) compared to poor collaterals (ratio >0.35).
- FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002).
Conclusions:
- FLAIR hyperintensity extent correlates with good collateral status in acute ischemic stroke patients eligible for reperfusion.
- ASPECTS assessment of FLAIR hyperintensities can rapidly identify patients who may benefit from reperfusion therapy.
