Journal
STROKE
Volume 43, Issue 11, Pages 2957-2961Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.112.658906
Keywords
acute stroke; diffusion-weighted; fluid-attenuated inversion recovery; magnetic resonance imaging; stroke
Categories
Funding
- Boehringer Ingelheim
- Lundbeck
- Siemens
- Syngis
- Synarc
- Bayer Vital
- EBS Technologies
- Glaxo Smith Kline
- Pfizer
- Sanofi Aventis
- Silk Road Medical
- UCB
- CoAxia
- Concentric Medical, Inc.
- Else Kro-ner-Fresenius-Stiftung
- French Government (PHRC)
- National Institutes of Health [R01NS059775, R01NS063925, P50NS051343]
- GE
- Olea
- Imaging Biometrics
- National Institute of Neurological Disorders and Stroke (NINDS)
- Else-Kroner-Fresenius-Stiftung [2009_A36]
- Federal Ministry of Education and Research via the grant Center for Stroke Research Berlin [01 EO 0801]
- European Union [202213, 223153]
- Volkswagen Foundation
- Deutsche Forschungsgemeinschaft
- National Health and Medical Research Council (Australia)
- National Stroke Foundation (Australia)
- Heart Foundation of Australia
- French national grant Le programme hospitalier de recherche Clinique (PHRC)
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Background and Purpose-Hyperintense vessels (HVs) have been observed in fluid-attenuated inversion recovery imaging of patients with acute ischemic stroke and been linked to slow flow in collateral arterial circulation. Given the potential importance of HV, we used a large, multicenter data set of patients with stroke to clarify which clinical and imaging factors play a role in HV. Methods-We analyzed data of 516 patients from the previously published PRE-FLAIR study (PREdictive value of FLAIR and DWI for the identification of acute ischemic stroke patients <= 3 and <= 4.5 hours of symptom onset-a multicenter study) study. Patients were studied by MRI within 12 hours of symptom onset. HV were defined as hyperintensities in fluid-attenuated inversion recovery corresponding to the typical course of a blood vessel that was not considered the proximal, occluded main artery ipsilateral to the diffusion restriction. Presence of HV was rated by 2 observers and related to clinical and imaging findings. Results-Presence of HV was identified in 240 of all 516 patients (47%). Patients with HV showed larger initial ischemic lesion volumes (median, 12.3 versus 4.9 mL; P<0.001) and a more severe clinical impairment (median National Institutes of Health Stroke Scale 10.5 versus 6; P<0.001). In 198 patients with MR angiography, HVs were found in 80% of patients with vessel occlusion and in 17% without vessel occlusion. In a multivariable logistic regression model, vessel occlusion was associated with HV (OR, 21.7%; 95% CI, 9.6-49.9; P<0.001). HV detected vessel occlusion with a specificity of 0.86 (95% CI, 0.80-0.90) and sensitivity of 0.76 (95% CI, 0.69-0.83). Conclusions-HVs are a common finding associated with proximal arterial occlusions and more severe strokes. HVs predict arterial occlusion with high diagnostic accuracy. (Stroke. 2012;43:2957-2961.)
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