Hyperintense vessels on imaging account for neurological function independent of lesion volume in acute ischemic stroke

Bunker, Lisa; Walker, Alexandra; Meier, Erin L.; Goldberg, Emily; Leigh, R. John; Hillis, Argye E.

doi:10.1016/j.nicl.2022.102991

Cited by 6 publications

(11 citation statements)

References 74 publications

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“…With validation of the location of hypoperfusion in these regions, the current study offers some validation of our previous work examining associations between NIH-FHV and behavioral outcomes [ 13 , 36 ]. For example, we reported a functional relationship between FHV scores in the MCA frontal region and performance on the NIH Stroke Scale (NIHSS) [ 37 ], which has been shown to be biased towards anterior lesions [ 38 ] and/or motor and language modalities [ 39 , 40 ].…”

Section: Discussionsupporting

confidence: 61%

“…Without such validation, the NIH-FHV scale could not be reliably used in clinical practice or research. In a previous smaller study ( n = 73), we found statistically significant relationships for FHV/PWI lesions in each vascular area, except the ACA territory [ 13 ], presumably due to low power (only three participants demonstrated FHVs in the ACA territory). The purpose of the current investigation was to examine the association between the location of FHVs on FLAIR and hypoperfusion in PWI in a larger cohort (i.e., the same cohort studied by Reyes et al), to hopefully replicate our previous findings, and potentially identify an association for the ACA territory.…”

Section: Introductionmentioning

confidence: 69%

“…In our prior work, we showed a significant relationship between the location of FHVs and perfusion deficits in PWI [ 13 ], but that study was in a retrospective analysis of imaging data from a subset of participants in a prospective, longitudinal study examining stroke recovery in right and left hemisphere strokes. Additionally, because the study was retrospective, some participants’ FLAIR imaging was acquired under different specifications (i.e., with different slice thicknesses), so some participants had more opportunities to demonstrate FHVs than others.…”

Section: Discussionmentioning

confidence: 99%

“…We have also demonstrated a relationship between NIH-FHV scores in the MCA parietal region, and content production during a discourse task and picture naming, independent of the lesion volume and age/education [ 13 ]. In another study, we found that various tests of hemispatial neglect were associated with NIH-FHV scores in different regions (e.g., NIH-FHV score in the MCA-P region was independently associated with line bisection, while viewer- and stimulus-centered errors on a gap detection task were associated with scores in the MCA-T and MCA-F areas, respectively) [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI

Bunker

Hillis

2023

JCM

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Perfusion imaging is preferred for identifying hypoperfusion in the management of acute ischemic stroke, but it is not always feasible/available. An alternative method for quantifying hypoperfusion, using FLAIR-hyperintense vessels (FHVs) in various vascular regions, has been proposed, with evidence of a statistical relationship with perfusion-weighted imaging (PWI) deficits and behavior. However, additional validation is needed to confirm that areas of suspected hypoperfusion (per the location of FHVs) correspond to the location of perfusion deficits in PWI. We examined the association between the location of FHVs and perfusion deficits in PWI in 101 individuals with acute ischemic stroke, prior to the receipt of reperfusion therapies. FHVs and PWI lesions were scored as present/absent in six vascular regions (i.e., the ACA, PCA, and (four sub-regions of) the MCA territories). Chi-square analyses showed a significant relationship between the two imaging techniques for five vascular regions (the relationship in the ACA territory was underpowered). These results suggest that for most areas of the brain, the general location of FHVs corresponds to hypoperfusion in those same vascular territories in PWI. In conjunction with prior work, results support the use of estimating the amount and location of hypoperfusion using FLAIR imaging when perfusion imaging is not available.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI

Bunker

Hillis

2023

JCM

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“…Recently, Bunker at al. validated the use of FHV scores in lieu of PWI in correlational analyses with language metrics in acute ischemic stroke [ 56 ]. We employed the NIH-FHV scoring system used by Reyes et al [ 55 ], which rates the number of hyperintense vessels per axial slice in each of six vascular territories in the affected (left) hemisphere.…”

Section: Methodsmentioning

confidence: 99%

The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke

Sharif

Goldberg²,

Walker³

et al. 2022

PLoS ONE

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Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.

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The volume and the distribution of premorbid white matter hyperintensities: Impact on post‐stroke aphasia

Vadinova,

Sihvonen,

Wee

et al. 2024

Human Brain Mapping

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White matter hyperintensities (WMH) are a radiological manifestation of progressive white matter integrity loss. The total volume and distribution of WMH within the corpus callosum have been associated with pathological cognitive ageing processes but have not been considered in relation to post‐stroke aphasia outcomes. We investigated the contribution of both the total volume of WMH, and the extent of WMH lesion load in the corpus callosum to the recovery of language after first‐ever stroke. Behavioural and neuroimaging data from individuals (N = 37) with a left‐hemisphere stroke were included at the early subacute stage of recovery. Spoken language comprehension and production abilities were assessed using word and sentence‐level tasks. Neuroimaging data was used to derive stroke lesion variables (volume and lesion load to language critical regions) and WMH variables (WMH volume and lesion load to three callosal segments). WMH volume did not predict variance in language measures, when considered together with stroke lesion and demographic variables. However, WMH lesion load in the forceps minor segment of the corpus callosum explained variance in early subacute comprehension abilities (t = −2.59, p = .01) together with corrected stroke lesion volume and socio‐demographic variables. Premorbid WMH lesions in the forceps minor were negatively associated with early subacute language comprehension after aphasic stroke. This negative impact of callosal WMH on language is consistent with converging evidence from pathological ageing suggesting that callosal WMH disrupt the neural networks supporting a range of cognitive functions.

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Hyperintense vessels on imaging account for neurological function independent of lesion volume in acute ischemic stroke

Cited by 6 publications

References 74 publications

Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI

Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI

The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke

The volume and the distribution of premorbid white matter hyperintensities: Impact on post‐stroke aphasia

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