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The value of FLAIR vascular hyperintensity-diffusion weighted imaging mismatch in assessing collateral circulation in acute ischemic stroke
QIU Yanhua  HUANG Lidong  CHEN Qiuyan  WENG Ye  SHI Liwei  WEI Dingtai 

Cite this article as: Qiu YH, Huang LD, CHEN QY, et al. The value of FLAIR vascular hyperintensity-diffusion weighted imaging mismatch in assessing collateral circulation in acute ischemic stroke[J]. Chin J Magn Reson Imaging, 2022, 13(3): 6-11, 65. DOI:10.12015/issn.1674-8034.2022.03.002.

[Abstract] Objective To evaluate the clinical value of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)-diffusion weighted imaging (DWI) mismatch in collateral circulation in patients with acute ischemic stroke (AIS).Materials and Methods We enrolled 37 patients with AIS. FVH, DWI lesion volume, FVH-DWI mismatch, arterial transit artifact (ATA), arterial spin labeling-cerebral blood flow (ASL-CBF) abnormal perfusion and clinical data including 90-day clinical outcome were collected to analyze the correlation between them.Results Compared to the no FVH-DWI mismatch group, patient with FVH-DWI mismatch had a higher FVH scores (4.57±1.87 vs. 1.13±2.24, P<0.001), a higher ATA scores (1.36±0.50 vs. 0.22±0.60, P<0.001), a higher proportion ASL perfusion abnormalities (P=0.001). FVH was highly associated with ASL-CBF abnormal perfusion (r=0.837, P<0.001), and in most cases, the range of FVH was close to the abnormal perfusion region of ASL-CBF. In the correlation analysis between ATA and FVH, FVH-DWI mismatch, we found that the correlation between ATA and FVH-DWI mismatch was better than that between ATA and FVH [(r=0.846, P<0.001) vs. (r=0.632, P<0.001)].Conclusions FVH-DWI mismatch was highly correlated with the ASL collateral circulation index ATA, which is helpful for clinical judgment of prognosis and guidance of treatment.
[Keywords] acute ischemic stroke;fluid-attenuated inversion recovery;diffusion weighted imaging;arterial transit artifact;arterial spin labeling

QIU Yanhua1, 2, 3   HUANG Lidong1, 2, 3   CHEN Qiuyan2, 3   WENG Ye1, 2, 3   SHI Liwei1, 2, 3   WEI Dingtai1, 2, 3*  

1 The Third Clinical Medical College, Fujian Medical University, Fuzhou 350000, China

2 Department of Radiology, Ningde Hospital Affiliated to Ningde Normal University, Ningde 352100, China

3 Functional and Molecular Imaging Laboratory for Cerebral Vascular Diseases, Ningde Hospital Affiliated to Ningde Normal University, Ningde 352100, China

Wei DT, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Fujian Medical University Sailing Foundation Project (No. 2020QH1340).
Received  2021-08-17
Accepted  2022-02-17
DOI: 10.12015/issn.1674-8034.2022.03.002
Cite this article as: Qiu YH, Huang LD, CHEN QY, et al. The value of FLAIR vascular hyperintensity-diffusion weighted imaging mismatch in assessing collateral circulation in acute ischemic stroke[J]. Chin J Magn Reson Imaging, 2022, 13(3): 6-11, 65. DOI:10.12015/issn.1674-8034.2022.03.002.

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association[J]. Circulation, 2016, 133(4): e38-e360. DOI: 10.1161/CIR.0000000000000350.
Bang OY, Saver JL, Buck BH, et al. Impact of collateral flow on tissue fate in acute ischaemic stroke[J]. J Neurol Neurosurg Psychiatry, 2008, 79(6): 625-629. DOI: 10.1136/jnnp.2007.132100.
Liebeskind DS. Collateral circulation[J]. Stroke, 2003, 34(9): 2279-2284. DOI: 10.1161/01.STR.0000086465.41263.06.
Heit JJ, Zaharchuk G, Wintermark M. Advanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment[J]. Neuroimaging Clin N Am, 2018, 28(4): 585-597. DOI: 10.1016/j.nic.2018.06.004.
Cosnard G, Duprez T, Grandin C, et al. Fast FLAIR sequence for detecting major vascular abnormalities during the hyperacute phase of stroke: a comparison with MR angiography[J]. Neuroradiology, 1999, 41(5): 342-346. DOI: 10.1007/s002340050761.
Hohenhaus M, Schmidt WU, Brunecker P, et al. FLAIR vascular hyperintensities in acute ICA and MCA infarction: a marker for mismatch and stroke severity?[J]. Cerebrovasc Dis, 2012, 34(1): 63-69. DOI: 10.1159/000339012.
Li CC, Hao XZ, Tian JQ, et al. Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores[J]. Neural Regen Res, 2018, 13(1): 69-76. DOI: 10.4103/1673-5374.224375.
Legrand L, Tisserand M, Turc G, et al. Do FLAIR vascular hyperintensities beyond the DWI lesion represent the ischemic penumbra?[J]. AJNR Am J Neuroradiol, 2015, 36(2): 269-274. DOI: 10.3174/ajnr.A4088.
Sogabe S, Satomi J, Tada Y, et al. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment[J]. Neuroradiology, 2017, 59(6): 587-595. DOI: 10.1007/s00234-017-1828-9.
Yoo RE, Yun TJ, Rhim JH, et al. Bright vessel appearance on arterial spin labeling MRI for localizing arterial occlusion in acute ischemic stroke[J]. Stroke, 2015, 46(2): 564-567. DOI: 10.1161/STROKEAHA.114.007797.
Barber PA, Demchuk AM, Zhang J, et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group, Alberta Stroke Programme Early CT Score[J]. Lancet, 2000, 355(9216): 1670-1674. DOI: 10.1016/s0140-6736(00)02237-6.
Jiang L, Peng M, Chen H, et al. Diffusion-weighted imaging (DWI) ischemic volume is related to FLAIR hyperintensity-DWI mismatch and functional outcome after endovascular therapy[J]. Quant Imaging Med Surg, 2020, 10(2): 356-367. DOI: 10.21037/qims.2019.12.05.
Di Napoli A, Cheng SF, Gregson J, et al. Arterial Spin Labeling MRI in Carotid Stenosis: Arterial Transit Artifacts May Predict Symptoms[J]. Radiology, 2020, 297(3): 652-660. DOI: 10.1148/radiol.2020200225.
Ahn SJ, Suh SH, Lee KY, et al. Hyperintense Vessels on T2-PROPELLER-FLAIR in Patients with Acute MCA Stroke: Prediction of Arterial Stenosis and Perfusion Abnormality[J]. AJNR Am J Neuroradiol, 2015, 36(11): 2042-2047. DOI: 10.3174/ajnr.A4423.
Haller S, Zaharchuk G, Thomas DL, et al. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications[J]. Radiology, 2016, 281(2): 337-356. DOI: 10.1148/radiol.2016150789.
Ding B, Jiang H, Zhang H, et al. Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: A Comparative Study with CT Perfusion Imaging in Transient Ischemic Attack Patients of Carotid Artery System[J]. J Clin Radiol, 2019, 38(6): 964-968. DOI: 10.13437/j.cnki.jcr.2019.06.005.
Liu W, Yin Q, Yao L, et al. Decreased hyperintense vessels on FLAIR images after endovascular recanalization of symptomatic internal carotid artery occlusion[J]. Eur J Radiol. 2012, 81(7): 1595-1600. DOI: 10.1016/j.ejrad.2011.04.026.
Sanossian N, Saver JL, Alger JR, et al. Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus[J]. AJNR Am J Neuroradiol, 2009, 30(3): 564-568. DOI: 10.3174/ajnr.A1388.
Zhai DY, Zhu SG, Zhang W, et al. Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)[J]. PLoS One, 2017, 12(11): e188078. DOI: 10.1371/journal.pone.0188078.
Akiyama T, Morioka T, Shimogawa T, et al. Arterial Spin-Labeling Magnetic Resonance Perfusion Imaging with Dual Postlabeling Delay in Internal Carotid Artery Steno-occlusion: Validation with Digital Subtraction Angiography[J]. J Stroke Cerebrovasc Dis, 2016, 25(9): 2099-2108. DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.005.
Niu HH, Zhang G, Zhang L, et al. Value of multimodal magnetic resonance imaging in the evaluation of collateral circulation after moderate and severe middle cerebral artery stenosis[J]. J Xinxiang Med Coll, 2020, 37(9): 873-876. DOI: 10.7683/xxyxyxb.2020.09.016.
Apfaltrer P, Wenz H, Bohme J, et al. FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis[J]. Clin Neuroradiol, 2020. DOI: 10.1007/s00062-020-00941-y.
Lee SH, Seo KD, Kim JH, et al. Correlation between Hyperintense Vessels on FLAIR Imaging and Arterial Circulation Time on Cerebral Angiography[J]. Magn Reson Med Sci, 2016, 15(1): 105-110. DOI: 10.2463/mrms.2015-0006.
Zeng L, Chen J, Liao H, et al. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians[J]. Front Aging Neurosci, 2021, 13: 790626. DOI: 10.3389/fnagi.2021.790626.
Guo JH, Tang SX, Peng W, et al. Study of consistency of three kinds of FLAIR vascular hyperintensity scoring[J]. Chin J Magn Reson Imaging, 2018, 9(5): 340-345. DOI: 10.12015/issn.1674-8034.2018.05.004.
Azizyan A, Sanossian N, Mogensen MA, et al. Fluid-attenuated inversion recovery vascular hyperintensities: an important imaging marker for cerebrovascular disease[J]. AJNR Am J Neuroradiol, 2011, 32(10): 1771-1775. DOI: 10.3174/ajnr.A2265.
Jing L, Sui B, Shen M, et al. Comparison of three FLAIR vascular hyperintensities methodologies in patients with acute ischemic stroke[J]. Acta Radiol, 2021, 62(6): 766-775. DOI: 10.1177/0284185120939271.
Wang LR, Gao ZG, Lu JF, et al. Value of 3D-ASL with Dual Postlabeling Delays in Evaluation Cerebral Hemodynamics Before and After Thrombectomy in Acute Cerebral Infarction[J]. J Clin Radiol, 2020, 39(5): 994-998. DOI: 10.13437/j.cnki.jcr.2020.05.034.
Lee KY, Kim JW, Park M, et al. Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke[J]. J Neuroradiol, 2021. DOI: 10.1016/j.neurad.2021.01.009.
Chen J, Yuan T, Quan GM, et al. Current status and prospective of hyperintense vessel sign in the evaluation of acute infarction in middle cerebral artery territories[J]. Int J Med Radiol, 2018, 41(4): 414-418, 435. DOI: 10.19300/j.2018.Z5442.
Jiang L, Peng M, Geng W, et al. FLAIR hyperintensities-DWI mismatch in acute stroke: associations with DWI volume and functional outcome[J]. Brain Imaging Behav, 2020, 14(4): 1230-1237. DOI: 10.1007/s11682-019-00156-x.
Luo X, Ruan ZB, Duan QH, et al. Analysis of correlation between FVH-DWI matching and prognosis in patients with ischemic stroke caused by middle cerebral artery occlusion[J]. Chin J Magn Reson Imaging, 2020, 11(4): 300-303. DOI: 10.12015/issn.1674-8034.2020.04.012.

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