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Published on: June 4, 2021
Posttreatment Follow-Up MR Imaging Biomarkers of Collateral Status Are Associated with Short-Term Outcomes in
Cynthia Greene1, Andrew Cho1, Hamza Adel Salim2,1,3
1From the Department of Radiology (C.G., A.C., H.A.S., D.A.L., M.H., J.M., H.L., A.E.H., R. Llinas, R.X. R. Leigh, V.Y.), Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland.
Background And Purpose:
FLAIR hyperintense vessels (FHV), quantified using the National Institutes of Health (NIH)-FHV score (NFS), and the SWI brush sign (SBS) are MRI markers associated with hemodynamic impairment in acute ischemic stroke (AIS). We aimed to evaluate the prognostic significance of posttreatment NFS and SBS in patients with anterior circulation large-vessel occlusion (AIS-LVO), including those with successful reperfusion.
Materials And Methods:
We retrospectively analyzed 273 patents with AIS-LVO with in-hospital follow-up MRI. NFS and SBS were evaluated and correlated with clinical outcomes including NIHSS shift (≥4-point improvement) and hemorrhagic transformation (HT). The Spearman correlation and logistic regression were performed, adjusting for clinical covariates. Analyses were repeated in the successfully reperfused subgroup of 181 cases (modified TICI [mTICI] ≥2b).
Results:
FHV and the SBS were observed posttreatment in 38% and 20% of patients, respectively. NFS and SBS were positively correlated (ρ = 0.54, P < .01). NFS inversely correlated with NIHSS shift (ρ = -0.27, P < .01) and reperfusion grade (mTICI; ρ = -0.32, P < .01). NFS was independently associated with worse NIHSS shift (OR, 0.64; P < .01) and reduced odds of HT (OR, 0.76; P < .01). Among patients with successful reperfusion, 20% of mTICI 3 cases showed FHV. In this subgroup, NFS remained predictive of poor NIHSS shift (OR, 0.57; P = .01). SBS alone was not independently associated with outcomes.
Conclusions:
NFS on posttreatment MRI is a robust imaging biomarker of persistent perfusion deficits and early neurologic outcome, even after successful reperfusion. SBS may reflect complementary collateral dynamics but showed limited independent prognostic utility.
Insights
The National Institutes of Health (NIH)-FHV score (NFS) on posttreatment MRI predicts early outcomes in acute ischemic stroke (AIS) patients. This imaging marker remains significant even after successful reperfusion, indicating persistent perfusion deficits.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- FLAIR hyperintense vessels (FHV) and SWI brush sign (SBS) are MRI markers of hemodynamic impairment in acute ischemic stroke (AIS).
- The NIH-FHV score (NFS) quantifies FHV, while SBS indicates microvascular changes.
Purpose of the Study:
- To assess the prognostic value of posttreatment NFS and SBS in patients with anterior circulation large-vessel occlusion (AIS-LVO).
- To evaluate these markers' significance in predicting outcomes, including successful reperfusion.
Main Methods:
- Retrospective analysis of 273 AIS-LVO patients with in-hospital follow-up MRI.
- Correlation of NFS and SBS with clinical outcomes like NIHSS shift and hemorrhagic transformation (HT).
- Logistic regression analysis, including subgroup analysis for successfully reperfused patients (mTICI ≥2b).
Main Results:
- Posttreatment FHV and SBS were observed in 38% and 20% of patients, respectively.
- NFS correlated positively with SBS and inversely with NIHSS shift and reperfusion grade.
- NFS independently predicted worse NIHSS shift and reduced odds of HT, even in successfully reperfused patients.
Conclusions:
- Posttreatment NFS is a reliable imaging biomarker for persistent perfusion deficits and early neurologic outcomes in AIS-LVO.
- SBS has limited independent prognostic utility, though it may reflect collateral dynamics.
- NFS is valuable for predicting outcomes post-reperfusion therapy.
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