FLAIR Distal hyperintense vessels as a marker of perfusion-diffusion mismatch in acute stroke

Diogo C. Haussen, Sebastian Koch, Efrat Saraf-Lavi, Tiesong Shang, Sushrut Dharmadhikari, Dileep R. Yavagal

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)397-400
Number of pages4
JournalJournal of Neuroimaging
Volume23
Issue number3
DOIs
StatePublished - Jul 2013

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Perfusion
Stroke
Angiography
Odds Ratio
Confidence Intervals
Tissue Plasminogen Activator
Brain Ischemia
Atrial Fibrillation
Multivariate Analysis
Retrospective Studies
Biomarkers
Demography

Keywords

  • Acute stroke
  • Angiography
  • Brain imaging
  • FLAIR
  • Infarction
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

FLAIR Distal hyperintense vessels as a marker of perfusion-diffusion mismatch in acute stroke. / Haussen, Diogo C.; Koch, Sebastian; Saraf-Lavi, Efrat; Shang, Tiesong; Dharmadhikari, Sushrut; Yavagal, Dileep R.

In: Journal of Neuroimaging, Vol. 23, No. 3, 07.2013, p. 397-400.

Research output: Contribution to journalArticle

Haussen, Diogo C. ; Koch, Sebastian ; Saraf-Lavi, Efrat ; Shang, Tiesong ; Dharmadhikari, Sushrut ; Yavagal, Dileep R. / FLAIR Distal hyperintense vessels as a marker of perfusion-diffusion mismatch in acute stroke. In: Journal of Neuroimaging. 2013 ; Vol. 23, No. 3. pp. 397-400.
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N2 - 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.

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