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FLAIR Distal Hyperintense Vessels as a Marker of Perfusion‐Diffusion Mismatch in Acute Stroke
Author(s) -
Haussen Diogo C.,
Koch Sebastian,
SarafLavi Efrat,
Shang Tiesong,
Dharmadhikari Sushrut,
Yavagal Dileep R.
Publication year - 2013
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2012.00784.x
Subject(s) - medicine , fluid attenuated inversion recovery , acute stroke , stroke (engine) , perfusion , perfusion scanning , diffusion mri , cardiology , radiology , magnetic resonance imaging , mechanical engineering , tissue plasminogen activator , engineering
BACKGROUND AND PURPOSE Distal hyperintense vessels (DHV) on MRI FLAIR sequences in acute brain ischemia are thought to represent leptomeningeal collateral flow. We hypothesized that DHV are more common in acute stroke patients with perfusion‐diffusion weighted mismatch (PDM) than in those without. METHODS We performed a retrospective study of consecutive anterior circulation stroke patients who underwent multimodal MRI within 8 hours of onset. We correlated DHV occurrence with the presence or absence of PDM, and analyzed DHV correlates when angiography was available. RESULTS Twenty‐one patients with PDM and 28 without were included. On univariate analysis, there was no significant difference regarding demographic variables between the two groups, with the exception of a higher frequency of atrial fibrillation (33% vs. 7%; P = .02) and intravenous tissue plasminogen activator use (57% vs 25%; P = .03) in the PDM patients. The PDM group more commonly had DHV (85% vs 25%; P < .001). On multivariate analysis, DHV presence (odds ratio, 6.01; 95% confidence‐interval, 1.08‐33.29; P = .04) and vessel occlusion site (odds ratio, 3.17; 95% confidence‐interval, 1.21‐8.31; P = .01) were the only variables independently associated with PDM. Conventional angiography was useful correlating DHV presence and collateral flow in a subset of patients. CONCLUSIONS DHV may be a surrogate marker for PDM in patients with hyperacute ischemic stroke.