title: Sulcal effacement on fluid attenuation inversion recovery magnetic resonance imaging in hyperacute stroke: association with collateral flow and clinical outcomes.
abstract: OBJECTIVE
  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 ≤ 2 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.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Suk Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Ha
authors.forename: Sookyung
authors.initials: S
authors.lastname: Ryoo
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Noh
authors.forename: Sam-Yeol
authors.initials: SY
authors.lastname: Ha
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D055815:Young Adult