title: Hyperintense basilar artery on FLAIR MR imaging: diagnostic accuracy and clinical impact in patients with acute brain stem stroke.
abstract: OBJECTIVE
  FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome.
  
  
  METHODS
  We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness.
  
  
  RESULTS
  The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05).
  
  
  CONCLUSIONS
  The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.
authors.affiliation: From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)Diagnostic and Interventional Radiology (M.G., J.O., P.V.) matthias.gawlitza@medizin.uni-leipzig.de.
authors.forename: M
authors.initials: M
authors.lastname: Gawlitza
authors.affiliation: From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.).
authors.forename: U
authors.initials: U
authors.lastname: Quäschling
authors.affiliation: Neurology (C.H.), University Hospital Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hobohm
authors.affiliation: Diagnostic and Interventional Radiology (M.G., J.O., P.V.).
authors.forename: J
authors.initials: J
authors.lastname: Otto
authors.affiliation: Diagnostic and Interventional Radiology (M.G., J.O., P.V.).
authors.forename: P
authors.initials: P
authors.lastname: Voigt
authors.affiliation: From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.).
authors.forename: K-T
authors.initials: KT
authors.lastname: Hoffmann
authors.affiliation: From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.).
authors.forename: D
authors.initials: D
authors.lastname: Lobsien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis*; D001488:Basilar Artery / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*