title: Fluid-Attenuated Inversion Recovery Vascular Hyperintensity Topography, Novel Imaging Marker for Revascularization in Middle Cerebral Artery Occlusion.
abstract: In acute arterial occlusion, fluid-attenuated inversion recovery vascular hyperintensity (FVH) has been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH topography or FVH-Alberta Stroke Program Early CT Score (ASPECTS) pattern and outcome in acute M1-middle cerebral artery occlusion patients with endovascular treatment.
  
  
  
  We included acute M1-middle cerebral artery occlusion patients treated with endovascular therapy (ET). All patients had diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery before ET. Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. The presence of FVH inside and outside DWI-positive lesions was separately analyzed. Clinical outcome after ET was analyzed with respect to different distal FVH-ASPECTS topography.
  
  
  
  Among 101 patients who met inclusion criteria for the study, mean age was 66.2±17.8 years and median National Institutes of Health Stroke Scale was 17.0 (interquartile range, 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (modified Rankin Scale [mRS] score of 0-2; 8.0 versus 4.0, P<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (odds ratio, 1.3; 95% confidence interval, 1.06-1.68; P=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhagic transformation (odds ratio, 1.3; 95% confidence interval, 1.04-1.51; P=0.019).
  
  
  
  Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing ET. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhagic transformation. The FVH pattern, not number, can serve as an imaging selection marker for ET in acute middle cerebral artery occlusion.
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Dezhi
authors.initials: D
authors.lastname: Liu
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Fabien
authors.initials: F
authors.lastname: Scalzo
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Neal M
authors.initials: NM
authors.lastname: Rao
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Hinman
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Wen
authors.initials: W
authors.lastname: Sun
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Dai
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles. davidliebeskind@yahoo.com xfliu2@vip.163.com.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D015415:Biomarkers
keywords: hypertension; magnetic resonance imaging; middle cerebral artery occlusion; stroke; thrombectomy