title: Clinical Implications of Sulcal Enhancement on Postcontrast Fluid Attenuated Inversion Recovery Images in Patients with Acute Stroke Symptoms.
abstract: OBJECTIVE
  Hyperintense acute reperfusion marker (HARM) without diffusion abnormalities is occasionally found in patients with an acute stroke. This study was to determine the prevalence and clinical implications of HARM without diffusion abnormalities.
  
  
  METHODS
  There was a retrospective review of magnetic resonance images 578 patients with acute strokes and identified those who did not have acute infarction lesions, as mapped by diffusion-weighted imaging (DWI). These patients were classified into an imaging-negative stroke and HARM without diffusion abnormalities groups, based on the DWI findings and postcontrast fluid attenuated inversion recovery images. The National Institutes of Health Stroke Scale (NIHSS) scores at admission, 1 day, and 7 days after the event, as well as clinical data and risk factors, were compared between the imaging-negative stroke and HARM without diffusion abnormalities groups.
  
  
  RESULTS
  Seventy-seven acute stroke patients without any DWI abnormalities were found. There were 63 patients with an imaging-negative stroke (accounting for 10.9% of 578) and 13 patients with HARM without diffusion abnormalities (accounting for 2.4% of 578). The NIHSS scores at admission were higher in HARM without diffusion abnormalities group than in the imaging-negative stroke group (median, 4.5 vs. 1.0; p < 0.001), but the scores at 7 days after the event were not significantly different between the two groups (median, 0 vs. 0; p = 1). The patients with HARM without diffusion abnormalities were significantly older, compared with patients with an imaging-negative stroke (mean, 73.1 years vs. 55.9 years; p < 0.001).
  
  
  CONCLUSIONS
  Patients with HARM without diffusion abnormalities are older and have similarly favorable short-term neurological outcomes, compared with the patients with imaging-negative stroke.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Hyukjoon
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea. ; Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 130-701, Korea.
authors.forename: Kyung Mi
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Bae
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Byoung Se
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology; D016896:Treatment Outcome; D014481:United States
chemical_list: D003287:Contrast Media
keywords: Acute stroke; HARM without diffusion abnormalities; Hyperintense acute reperfusion marker; Postcontrast FLAIR imaging