FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion

Hasan H. Karadeli, Dan-Victor Giurgiutiu, Lisa Cloonan, Kaitlin Fitzpatrick, Allison Kanakis, Muhammed E. Ozcan, Lee H. Schwamm, Natalia S. Rost

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. METHODS: Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. RESULTS: Among 39 patients (mean age 70.5 ± 12.7 years; 56% women, mean National Institutes of Health Stroke Scale score 17.2 (± 4.4)), median WMHV was 6.0 cm3. FVH score and collateral flow grade were significantly correlated (Spearman's ρ = .41, P = .009). In a univariate regression model, FVH degree was inversely associated with WMHV (β = -.33, P = .04). CONCLUSIONS: FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.

Original languageEnglish (US)
Pages (from-to)219-223
Number of pages5
JournalJournal of Neuroimaging
Volume26
Issue number2
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Leukoaraiosis
Blood Vessels
Arteries
Stroke
National Institutes of Health (U.S.)
Tissue Plasminogen Activator
Databases

Keywords

  • Acute ischemic stroke (AIS)
  • Collateral
  • Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)
  • Leukoaraiosis
  • White matter disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion. / Karadeli, Hasan H.; Giurgiutiu, Dan-Victor; Cloonan, Lisa; Fitzpatrick, Kaitlin; Kanakis, Allison; Ozcan, Muhammed E.; Schwamm, Lee H.; Rost, Natalia S.

In: Journal of Neuroimaging, Vol. 26, No. 2, 01.03.2016, p. 219-223.

Research output: Contribution to journalArticle

Karadeli, Hasan H. ; Giurgiutiu, Dan-Victor ; Cloonan, Lisa ; Fitzpatrick, Kaitlin ; Kanakis, Allison ; Ozcan, Muhammed E. ; Schwamm, Lee H. ; Rost, Natalia S. / FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion. In: Journal of Neuroimaging. 2016 ; Vol. 26, No. 2. pp. 219-223.
@article{4c0226071b6e440dad97347aa3703de5,
title = "FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion",
abstract = "BACKGROUND: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. METHODS: Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. RESULTS: Among 39 patients (mean age 70.5 ± 12.7 years; 56{\%} women, mean National Institutes of Health Stroke Scale score 17.2 (± 4.4)), median WMHV was 6.0 cm3. FVH score and collateral flow grade were significantly correlated (Spearman's ρ = .41, P = .009). In a univariate regression model, FVH degree was inversely associated with WMHV (β = -.33, P = .04). CONCLUSIONS: FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.",
keywords = "Acute ischemic stroke (AIS), Collateral, Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), Leukoaraiosis, White matter disease",
author = "Karadeli, {Hasan H.} and Dan-Victor Giurgiutiu and Lisa Cloonan and Kaitlin Fitzpatrick and Allison Kanakis and Ozcan, {Muhammed E.} and Schwamm, {Lee H.} and Rost, {Natalia S.}",
year = "2016",
month = "3",
day = "1",
doi = "10.1111/jon.12274",
language = "English (US)",
volume = "26",
pages = "219--223",
journal = "Journal of Neuroimaging",
issn = "1051-2284",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion

AU - Karadeli, Hasan H.

AU - Giurgiutiu, Dan-Victor

AU - Cloonan, Lisa

AU - Fitzpatrick, Kaitlin

AU - Kanakis, Allison

AU - Ozcan, Muhammed E.

AU - Schwamm, Lee H.

AU - Rost, Natalia S.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - BACKGROUND: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. METHODS: Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. RESULTS: Among 39 patients (mean age 70.5 ± 12.7 years; 56% women, mean National Institutes of Health Stroke Scale score 17.2 (± 4.4)), median WMHV was 6.0 cm3. FVH score and collateral flow grade were significantly correlated (Spearman's ρ = .41, P = .009). In a univariate regression model, FVH degree was inversely associated with WMHV (β = -.33, P = .04). CONCLUSIONS: FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.

AB - BACKGROUND: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. METHODS: Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. RESULTS: Among 39 patients (mean age 70.5 ± 12.7 years; 56% women, mean National Institutes of Health Stroke Scale score 17.2 (± 4.4)), median WMHV was 6.0 cm3. FVH score and collateral flow grade were significantly correlated (Spearman's ρ = .41, P = .009). In a univariate regression model, FVH degree was inversely associated with WMHV (β = -.33, P = .04). CONCLUSIONS: FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.

KW - Acute ischemic stroke (AIS)

KW - Collateral

KW - Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)

KW - Leukoaraiosis

KW - White matter disease

UR - http://www.scopus.com/inward/record.url?scp=84959235797&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959235797&partnerID=8YFLogxK

U2 - 10.1111/jon.12274

DO - 10.1111/jon.12274

M3 - Article

VL - 26

SP - 219

EP - 223

JO - Journal of Neuroimaging

JF - Journal of Neuroimaging

SN - 1051-2284

IS - 2

ER -