Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

Zeng, Lichuan; Chen, Jinxin; Liao, Huaqiang; Wang, Qu; Xie, Mingguo; Wu, Wenbin

doi:10.3389/fnagi.2021.790626

Cited by 5 publications

(4 citation statements)

References 52 publications

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“…In comparison, in the majority of studies that demonstrated an association between FVH and unfavorable outcomes, the symptom-to-imaging time was 12–24 h or longer [ 36 – 38 ]. Our findings confirmed that FVH was independently associated with poor prognosis, which we believe is related to the fact that the patients we enrolled who did not receive timely vessel recanalization and underwent MR scanning within 72 h. Previous studies believed that FVH may serve as an imaging marker of leptomeningeal collaterals within 6 h of symptom onset or within the time window of reperfusion treatment [ 39 ]. The extent of FVH may indicate the amount of brain tissue vulnerable to ischemia, which can be reversed with reperfusion therapy to reduce the size of the eventual lesion and improve functional outcomes.…”

Section: Discussionsupporting

confidence: 84%

FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome

Xiang,

Wei,

Liang

et al. 2023

Eur J Med Res

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Background To investigate the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH) within asymmetrical prominent veins sign (APVS) on susceptibility-weighted imaging predicting collateral circulation and prognosis in patients with acute anterior circulation ischemic stroke. Method Patients with severe stenosis or occlusion of ICA or MCA M1, who underwent MRI within 72 h from stroke onset were reviewed. The Alberta Stroke Program Early CT Score was used to evaluate the volume of infarction on DWI, the degree of FVH and APVS. Spearman correlation analysis was used to evaluate the correlation between FVH and APVS. All patients were divided into the good prognosis group and the poor prognosis group according to the score of the modified ranking scale (mRS) 90 days after the stroke. Logistic regression analysis was used to explore the relationship between FVH and APVS and functional prognosis, while receiver operating characteristic (ROC) curves were plotted to assess the value of FVH and APVS in predicting prognosis. Results Spearman correlation analysis revealed moderate positive correlations between FVH and APVS (r = 0.586, P < 0.001). The poor prognosis group had a higher rate of a history of atrial fibrillation, a larger cerebral infarction volume, a higher NIHSS score at admission, and a higher FVH and APVS score compared with the good prognosis group (all P < 0.05). A further logistic regression indicated that the NIHSS score, cerebral infarction volume, FVH and APVS were independent risk factors for a poor functional prognosis. In terms of FVH, APVS, alone and their combination for the diagnosis of poor prognosis, the sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (CI) were 86.8%, 83.3%, 0.899 (95% CI 0.830–0.968); 60.5%, 93.7%, 0.818 (95% CI 0.723–0.912); 86.8%, 89.6%, 0.921 (95% CI 0.860–0.981), respectively. Conclusion The presence of FVH and APVS can provide a comprehensive assessment of collateral circulation from the perspective of veins and arteries, and the correlation between the two is positively correlated. Both of them were independent risk factors for poor prognosis, their combination is complementary and can improve the predictive value.

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Section: Discussionsupporting

confidence: 84%

FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome

Xiang,

Wei,

Liang

et al. 2023

Eur J Med Res

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“…1 Third, MR images were mainly obtained within 4 hours of stroke onset, and results might differ at later time points when information on collaterals might be more useful for treatment decisions. 10,11 Fourth, some patients were excluded because of FLAIR artifacts; however, this exclusion concerned ,2% of the total sample. Fifth, although ratings of FVH ASPECTS and FVH-DWI mismatch ASPECTS remain subjective, interobserver agreement was good.…”

Section: Discussionmentioning

confidence: 99%

“…Although FVH have been proposed as a surrogate marker of collateral status, 9 the relation between FVH and collateral status remains incompletely understood. 10,11 Actually, FVH may not only represent retrograde collateral flow but also reflect slow anterograde flow or even stationary blood.…”

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confidence: 99%

FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters

Legrand¹,

Berre²,

Seners³

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS:We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS:Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P ¼ .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P , .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P , .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P , .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P ¼ .02). CONCLUSIONS:In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

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“… 9 Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) are serpentine or linear hyperintensities that are best visualized within the Sylvian fissure ipsilateral to acute ischemic stroke. 10 , 11 FVH has demonstrated good diagnostic performance for the identification of LASO in stroke, but the relationship between FVH and TIA is still undetermined. The purpose of this study was to investigate the prevalence of FVH and the clinical–radiological correlation in patients with TIA.…”

Section: Introductionmentioning

confidence: 99%

FLAIR Vascular Hyperintensity: An Important MRI Marker in Patients with Transient Ischemic Attack

Zeng¹,

Wang²,

Liao³

et al. 2022

IJGM

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Purpose We aimed to investigate the prevalence of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) and the clinical–radiological correlation in transient ischemic attack (TIA) patients. Materials and Methods We performed a retrospective analysis of TIA patients who had undergone magnetic resonance imaging (MRI) within 24 h of symptom onset. Two independent neuroradiologists investigated the presence of FVHs, large-artery severe stenosis or occlusion (LASO) in magnetic resonance angiograms, and the nature of factors associated with FVH. Results A total of 207 patients were enrolled in this study. FVHs were detected in 42 (20.3%) patients, in whom atrial fibrillation (AF) was confirmed in 25 (59.5%) cases and LASO was confirmed in 30 (71.4%) cases. The corresponding figures were 33 (20.0%) and 10 (6.1%), respectively, for the 165 FVH-negative patients. Logistic regression analysis showed that time from symptom onset to MRI (odds ratio [OR] = 0.82, 95% CI 0.76–0.97, p = 0.042), previous stroke (OR = 2.95, 95% CI 1.58–6.74, p = 0.002), AF (OR = 5.83, 95% CI 2.24–9.46, p < 0.001), and LASO (OR = 4.28, 95% CI 2.96–10.28, p < 0.001) were independently associated with FVH. Overall, the sensitivity and specificity of FVH for predicting LASO were 0.75 and 0.93, respectively, and the positive predictive value, negative predictive value, and accuracy were 0.71, 0.94, and 0.89, respectively. The area under the receiver operating characteristic curve was 0.839. FVH-positive TIA patients with LASO had less AF (14 [46.7%] versus 11 [91.7%], p = 0.019) and longer times from symptom onset to MRI (6.8 ± 2.8 h versus 4.8 ± 1.3 h, p = 0.004) than those without LASO. Conclusion The presence of FVH could be an important marker in TIA patients. Many factors, including LASO, AF, and time from symptom onset to MRI, are associated with the detection of FVH.

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Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

Cited by 5 publications

References 52 publications

FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome

FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome

FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters

FLAIR Vascular Hyperintensity: An Important MRI Marker in Patients with Transient Ischemic Attack

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