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Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a
Dong Hyuk Shin1, Sang Kuk Han1, Jang Hee Lee1
1Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Background:
A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries.
Purpose:
To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA).
Material And Methods:
The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively.
Results:
The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781-121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis.
Conclusion:
A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.
Insights
The hyper-intense vessel sign (FHV) on MRI indicates slow blood flow. A proximal FHV (pFHV) strongly correlates with acute large vessel occlusion in stroke patients, guiding urgent intervention.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- The hyper-intense vessel sign (FHV) on fluid-attenuated inversion recovery magnetic resonance imaging (MRI) reflects slow blood flow in cerebral arteries.
- This sign is crucial for diagnosing hyper-acute ischemic strokes.
Purpose of the Study:
- To determine the association between the proximal FHV (pFHV) on initial MRI and the status of the affected artery (stenosis or occlusion) in patients with hyper-acute middle cerebral artery (MCA) strokes.
- To evaluate the diagnostic value of pFHV in identifying large vessel occlusion.
Main Methods:
- Retrospective analysis of 105 patients with acute MCA infarction within 4.5 hours of symptom onset.
- All patients underwent brain MRI and angiography shortly after emergency department arrival.
- Culprit vessel status and presence of pFHV on initial MRI were assessed.
Main Results:
- A pFHV was detected in 67.6% of patients with hyper-acute MCA infarction.
- A pFHV was present in nearly all cases of internal carotid artery occlusion and M1/M2 segment MCA occlusions.
- Logistic regression confirmed a strong positive correlation between pFHV and large vessel occlusion (aOR 34.533, P < 0.001), but not severe stenosis.
Conclusions:
- The proximal FHV (pFHV) is a reliable indicator of acute occlusion in proximal arteries within the MCA territory.
- Early identification of pFHV in hyper-acute MCA infarction warrants aggressive treatment strategies and prompt intervention team activation for improved patient outcomes.
