Evaluation of hyperintense vessels on FLAIR MRI for the diagnosis of multiple intracerebral arterial stenoses.
OBJECTIVE
Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) has been described in hyperacute stroke patients with arterial occlusion. We sought to determine whether HVS was more frequent in patients with intracerebral arterial stenoses than in those without stenosis regardless of the presence of a brain infarct.


METHODS
In this case-control study (19 symptomatic patients with multiple intracerebral arterial stenoses compared with 19 age-matched asymptomatic patients without stenosis), we looked for HVS (ie, focal or tubular hyperintensities in the subarachnoid space) on FLAIR images. We compared the proportion of HVS-positive patients in the 2 groups and evaluated the concordance between the arterial distribution of stenoses on angiogram and that of HVS on FLAIR.


RESULTS
HVS was found in 13 of 19 patients (68%) in the study group and 1 of 19 control patients (5.2%) (P<0.0001). The concordance between the territorial distribution of stenoses on angiogram and HVS on FLAIR was higher for the right and left middle cerebral artery (kappa=0.6 and 0.63, respectively) compared with the right and left anterior cerebral artery (kappa=0.35 and 0.2, respectively). HVSs were observed in 1 of 7 patients with posterior cerebral artery stenoses on angiogram. HVSs were seen equally in patients with acute focal (7 of 10) or diffuse (6 of 9) cerebral involvement. In the 6 HVS-positive patients with acute stroke confirmed by MRI, additional HVSs were observed in a different arterial territory than that of the stroke lesion.


CONCLUSIONS
Although their significance remains unclear, multiple HVSs are more frequently observed in symptomatic patients with multiple intracerebral stenoses than in asymptomatic patients without stenosis.
Iancu-Gontard
Daniela
D
Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Université Paris V, Paris, France.
Oppenheim
Catherine
C
Touzé
Emmanuel
E
Méary
Eric
E
Zuber
Mathieu
M
Mas
Jean-Louis
JL
Frédy
Daniel
D
Meder
Jean-François
JF
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D016022:Case-Control Studies; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013346:Subarachnoid Space / Q000098:blood supply; D020293:Vasculitis, Central Nervous System / Q000150:complications / Q000175:diagnosis