Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)

PLOS ONE, Nov 2019

We aim to evaluate the value of fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) in assessing infarct morphology in patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. Magnetic resonance (MR) diffusion-weighted imaging (DWI) FLAIR sequences, and carotid/cerebral magnetic resonance angiography of 102 patients with symptomatic ICA or MCA occlusions were evaluated. The location and score of FVH were determined using Olindo’s method; patients were classified as having Low or High FVHs based on FVH score, and either Distal or Proximal FVH based on FVH location. The differences between infarct morphologies were analyzed. FVH were detectable in 62 patients with High FVH and in 40 patients with Low FVHs based on the Olindo’s scale. There were no statistically significant differences in age, gender, hypertension, diabetes, hyperlipidemia, smoking history, and vascular occlusive site between High and Low FVHs patients, except for infarct morphology (P<0.01). Patients with Distal FVH presented with significant (P<0.01) perforating artery and border zone infarcts, whereas those with Proximal FVH had significant (P<0.01) large territorial infarcts. The scores and locations of FVH could be a predictive imaging marker for infarct morphology in patients with symptomatic ICA or MCA occlusion.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0188078&type=printable

Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH)

November Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) Deng-Yue Zhai 0 1 2 Shuang-Gen Zhu 0 2 Wei Zhang 0 2 Xue Li 0 1 2 You-Ling Zhu 0 1 2 0 Funding: This project was supported by the Natural Science Foundation of Anhui Medical University (2013xkj048), Anhui Provincial Natural Science Research Project (kj2013z119). Innovation Technology Funding Project of Longhua District , Shenzhen, China (20150924A1030082) , and Medical Scientific Research Foundation of Guangdong Province , China, B2016091 1 Department of Neurology, the Third Affiliated Hospital of Anhui Medical University , Hefei, Anhui Province , China , 2 Department of Neurology, People's Hospital of Longhua , Shenzhen, Guangdong Province, People's Republic China , 3 Department of Neurology, the Second People's Hospital of Anhui Province , Hefei, Anhui Province , China 2 Editor: Quan Jiang, Henry Ford Health System , UNITED STATES We aim to evaluate the value of fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) in assessing infarct morphology in patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. Magnetic resonance (MR) diffusion-weighted imaging (DWI) FLAIR sequences, and carotid/cerebral magnetic resonance angiography of 102 patients with symptomatic ICA or MCA occlusions were evaluated. The location and score of FVH were determined using Olindo's method; patients were classified as having Low or High FVHs based on FVH score, and either Distal or Proximal FVH based on FVH location. The differences between infarct morphologies were analyzed. FVH were detectable in 62 patients with High FVH and in 40 patients with Low FVHs based on the Olindo's scale. There were no statistically significant differences in age, gender, hypertension, diabetes, hyperlipidemia, smoking history, and vascular occlusive site between High and Low FVHs patients, except for infarct morphology (P<0.01). Patients with Distal FVH presented with significant (P<0.01) perforating artery and border zone infarcts, whereas those with Proximal FVH had significant (P<0.01) large territorial infarcts. The scores and locations of FVH could be a predictive imaging marker for infarct morphology in patients with symptomatic ICA or MCA occlusion. - Data Availability Statement: All relevant data are within its Supporting Information files. Introduction Cerebral collateral circulations can be classified as the extra cranial-intracranial collateral circulation, Willis's cycle, and leptomeningeal collateral circulation. Good collateral circulation can restrain the infarct range of ischemic strokes, and predict the clinical manifestations and prognoses [ 1 ] of patients with an infarct. Miteff et al. [ 2 ] considered good collateral circulation as a useful indicator of excellent prognosis of thrombolytic therapy. Huang et al [ 3 ] found that good collateral circulation had a positive effect on the clinical manifestations and prognosis of Competing interests: The authors have declared that no competing interests exist. patients with acute cerebral infarcts; and it may provide an evaluation of the benefits of early thrombolytic therapy in those patients. Currently, cerebral angiography has been the gold standard for the assessment of intracranial collateral circulation; however it has not been widely applied due to its disadvantages such as invasiveness and high cost. The pathogenesis of these lesions may be a result of the distal slow and disordered blood flow of the occlusive vessels. Fast fluid-attenuated inversion recovery (FLAIR) is a pulse sequence that is used in magnetic resonance imaging (MRI). It is an inversion recovery technique and can be used for brain imaging to bring out the periventricular hypertensive lesions such as those seen in patients with multiple sclerosis, infarction, subarachnoid hemorrhage, and many more [4±6]. FLAIR vascular hyperintensity (FVH) [ 7 ] is an abnormal hyperintense vascular shadow found on MRI in patients with ischemic strokes. Some recent studies [ 3, 8 ] have verified the association between FVH and severe vascular stenosis or occlusion. Furthermore, FLAIR functions on the basis of a T2-weighted sequence and cerebrospinal fluid (CSF) signal suppression is enabled for better lesion perceptibility in brain parenchyma when there is direct contact of CSF space with the infarct zone. Additionally, slow flow and immobility result in a highpitched signal on FLAIR in comparison to the normal `flow void' occurrence of arteries [9]. A distinction between proximal (internal carotid artery, ICA, or M1-middle cerebral artery, M1-MCA) hyperintensities and distal (Sylvian fissure or cortical surface) FVH is essential because it is assumed that proximal vessel signs in the MCA territory represent a thrombus, whereas distal FVH represents slow blood (...truncated)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0188078&type=printable

Deng-Yue Zhai, Shuang-Gen Zhu, Wei Zhang, Xue Li, You-Ling Zhu. Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), PLOS ONE, 2017, Volume 12, Issue 11, DOI: 10.1371/journal.pone.0188078