Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke

Abstract

Background and Purpose-The clinical significance of sulcal effacement has been widely investigated in CT studies, but the results are controversial. In this study, we evaluated the presence of perisylvian sulcal effacement (PSE) on fluid attenuation inversion recovery MRI and hypothesized that PSE may be related to collateral flow status together with hyperintense vessels on fluid attenuation inversion recovery in hyperacute stroke. In addition, we investigated whether an association between PSE and clinical outcome could be found in these patients. Methods-Consecutive patients with acute middle cerebral artery infarcts within 6 hours of symptom onset were included.All patients had internal carotid artery or middle cerebral artery occlusion and underwent MRI including FLAIR. The presence of PSE and hyperintense vessels on fluid attenuation inversion recovery and the collateral status and occurrence of early recanalization (ER) on conventional angiography were evaluated. Results-Of 139 patients, 79 (56.8%) had PSE. Multivariate testing revealed PSE was independently associated with collateral status. The association between hyperintense vessels and collaterals was different depending on PSE.Compared to PSE-positive and ER-negative patients, PSE-negative and ER-negative patients (odds ratio, 4.11; 95% confidence interval, 1.12-15.17) and PSE-negative and ER-positive patients (odds ratio, 34.62; 95% confidence interval, 5.75-208.60), but not PSE-positive and ER-positive patients, were more likely to experience favorable clinical outcomes (modified Rankin Scale score Յ2 at 3 months). Conclusions-PSE is independently associated with collateral status in patients with acute middle cerebral artery stroke. Moreover, PSE in conjunction with recanalization status can predict clinical outcomes in these patients. (Stroke. 2012;43:386-392.)

Sulcal Effacement With Preserved Gray–White Junction

“…1 However, sulcal effacement continues to be broadly referred to as a marker of early ischemic changes and has been imprecisely used as a sign of parenchymal injury. 3,5,10 Our findings reinforce the idea that sulcal effacement without hypoattenuation and with preserved gray-white junction represents viable tissue. The development of ISE happens before the occurrence of cytotoxic edema (leading to loss of graywhite differentiation) and of blood-brain barrier breakdown (leading to vasogenic edema and hypoattenuation).…”

Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

“…Second, we were unable to establish the relationship between a quantitative estimation of HVs and the distribution of LMCs or cerebral hemodynamics. Additionally, distal HVs in conjunction with other information from FLAIR may more accurately reflect collateral status [13,22]. Finally, the FLAIR images were obtained by 1.5- and 3.0-tesla field strengths.…”

Collateral Circulation in Ischemic Stroke

“…The presence of distal hyperintense vessels or fluid attenuation inversion recovery vascular hyperintensities and the absence of perisylvian sulcal effacement are associated with good collaterals and favorable outcome in patients with acute middle cerebral artery stroke. 4647 Similarly, conspicuous flow voids, deoxygenation seen as hypointensity, or disappearing phase mismapping on gradient echo image may also be clues about the collateral status. 48 …”