title: FLAIR distal hyperintense vessels as a marker of perfusion-diffusion mismatch in acute stroke.
abstract: OBJECTIVE
  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.
authors: Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Neurology, Miami, FL, USA.
authors: Diogo C
authors: DC
authors: Haussen
authors: Sebastian
authors: S
authors: Koch
authors: Efrat
authors: E
authors: Saraf-Lavi
authors: Tiesong
authors: T
authors: Shang
authors: Sushrut
authors: S
authors: Dharmadhikari
authors: Dileep R
authors: DR
authors: Yavagal
mesh_terms: D000368:Aged; D002536:Cerebral Arteries / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology* / Q000473:pathology*
keywords: Acute stroke; FLAIR; MRI; angiography; brain imaging; infarction