title: Hyperintense vessels on acute stroke fluid-attenuated inversion recovery imaging: associations with clinical and other MRI findings.
abstract: OBJECTIVE
  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.
authors.affiliation: Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany. b.cheng@uke.uni-hamburg.de
authors.forename: Bastian
authors.initials: B
authors.lastname: Cheng
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.forename: Anna
authors.initials: A
authors.lastname: Kufner
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Ona
authors.initials: O
authors.lastname: Wu
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: David
authors.initials: D
authors.lastname: Liebeskind
authors.forename: Thomas
authors.initials: T
authors.lastname: Tourdias
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.forename: Soren
authors.initials: S
authors.lastname: Christensen
authors.forename: Steve
authors.initials: S
authors.lastname: Warach
authors.forename: Marie
authors.initials: M
authors.lastname: Luby
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000473:pathology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000473:pathology*