title: Hyperintense Vessels on T2-PROPELLER-FLAIR in Patients with Acute MCA Stroke: Prediction of Arterial Stenosis and Perfusion Abnormality.
abstract: OBJECTIVE
  Fluid-attenuated inversion recovery hyperintense vessels in stroke represent leptomeningeal collateral flow. We presumed that FLAIR hyperintense vessels would be more closely associated with arterial stenosis and perfusion abnormality in ischemic stroke on T2-PROPELLER-FLAIR than on T2-FLAIR.
  
  
  METHODS
  We retrospectively reviewed 35 patients with middle cerebral territorial infarction who underwent MR imaging. FLAIR hyperintense vessel scores were graded according to the number of segments with FLAIR hyperintense vessels in the MCA ASPECTS areas. We compared the predictability of FLAIR hyperintense vessels between T2-PROPELLER-FLAIR and T2-FLAIR for large-artery stenosis. The interagreement between perfusion abnormality and FLAIR hyperintense vessels was assessed. In subgroup analysis (9 patients with MCA horizontal segment occlusion), the association of FLAIR hyperintense vessels with ischemic lesion volume and perfusion abnormality volume was evaluated.
  
  
  RESULTS
  FLAIR hyperintense vessel scores were significantly higher on T2-PROPELLER-FLAIR than on T2-FLAIR (3.50 ± 2.79 versus 1.21 ± 1.47, P < .01), and the sensitivity for large-artery stenosis was significantly improved on T2-PROPELLER-FLAIR (93% versus 68%, P = .03). FLAIR hyperintense vessels on T2-PROPELLER-FLAIR were more closely associated with perfusion abnormalities than they were on T2-FLAIR (κ = 0.64 and κ = 0.27, respectively). In subgroup analysis, FLAIR hyperintense vessels were positively correlated with ischemic lesion volume on T2-FLAIR, while the mismatch of FLAIR hyperintense vessels between the 2 sequences was negatively correlated with ischemic lesion volume (P = .01).
  
  
  CONCLUSIONS
  In MCA stroke, FLAIR hyperintense vessels were more prominent on T2-PROPELLER-FLAIR compared with T2-FLAIR. In addition, FLAIR hyperintense vessels on T2-PROPELLER-FLAIR have a significantly higher sensitivity for predicting large-artery stenosis than they do on T2-FLAIR. Moreover, the areas showing FLAIR hyperintense vessels on T2-PROPELLER-FLAIR were more closely associated with perfusion abnormality than those on T2-FLAIR.
authors.affiliation: From the Departments of Radiology (S.J.A., S.H.S.).
authors.forename: S J
authors.initials: SJ
authors.lastname: Ahn
authors.affiliation: From the Departments of Radiology (S.J.A., S.H.S.) Severance Institute for Vascular and Metabolic Research (S.H.S., K.-Y.L.), Yonsei University, Seoul, Korea.
authors.forename: S H
authors.identifier: http://orcid.org/0000-0002-7098-4901
authors.initials: SH
authors.lastname: Suh
authors.affiliation: Neurology (K.-Y.L., J.H.K., K.-D.S.), Yonsei University College of Medicine, Seoul, Korea Severance Institute for Vascular and Metabolic Research (S.H.S., K.-Y.L.), Yonsei University, Seoul, Korea kylee@yuhs.ac.
authors.forename: K-Y
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Neurology (K.-Y.L., J.H.K., K.-D.S.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Neurology (K.-Y.L., J.H.K., K.-D.S.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: K-D
authors.initials: KD
authors.lastname: Seo
authors.affiliation: Global Applications and Workflow (S.L.), GE Healthcare, Seoul, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies