Center for Stroke Research Berlin and Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
Cerebrovasc Dis. 2012;34(1):63-9. doi: 10.1159/000339012. Epub 2012 Jun 28.
Vascular hyperintensities of brain-supplying arteries on stroke FLAIR MRI are common and represent slow flow or stasis. FLAIR vascular hyperintensities (FVH) are discussed as an independent marker for cerebral hypoperfusion, but the impact on infarct size and clinical outcome in acute stroke patients is controversial. This study evaluates the association of FVH with infarct morphology, clinical stroke severity and infarct growth in patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.
MR images of 84 patients [median age 73 years (IQR 65-80), 56.0% male, median NIHSS 7 (IQR 3-13)] with acute stroke due to symptomatic ICA or MCA occlusion or stenosis were reviewed. Vessel occlusions were identified by MRA time of flight and graded with the TIMI score. Diffusion and perfusion deficit volumes on admission and FLAIR lesion volumes on discharge were assessed. The presence and number of FVH were evaluated according to MCA-ASPECT areas, and associations with MR volumes, morphology of infarction, recanalization status, presence of white matter disease and hemorrhagical transformation as well as with stroke severity (NIHSS), stroke etiology and thrombolysis rate were analyzed.
FVH were detectable in 75 (89.3%) patients. The median number of FVH was 4 (IQR 2-7). Patients with FVH >4 presented with more severe strokes due to NIHSS (p = 0.021), had larger initial DWI lesions (p = 0.008), perfusion deficits (p = 0.001) and mismatch volumes/ratios (p = 0.005). The final infarct volume was larger (p = 0.005), and hemorrhagic transformation was more frequent (p = 0.029) in these patients.
The presence of FVH indicates larger ischemic areas in brain parenchyma predominantly caused by proximal anterior circulation vessel occlusion. A high count of FVH might be a further surrogate marker for initial ischemic mismatch and stroke severity.
在中风 FLAIR MRI 上，脑供血动脉的血管高信号是常见的，代表着血流缓慢或停滞。FLAIR 血管高信号（FVH）被认为是脑灌注不足的独立标志物，但在急性中风患者中，其与梗死面积和临床预后的关系仍存在争议。本研究评估了 FVH 与症状性颈内动脉（ICA）或大脑中动脉（MCA）闭塞患者的梗死形态、临床中风严重程度和梗死进展的关系。
回顾了 84 例因症状性 ICA 或 MCA 闭塞或狭窄导致急性中风的患者（中位年龄 73 岁[IQR 65-80]，56.0%男性，中位 NIHSS 7 分[IQR 3-13]）的 MRI 图像。通过 MRA 时间飞越法识别血管闭塞，并根据 TIMI 评分进行分级。入院时评估弥散和灌注缺损体积，出院时评估 FLAIR 病变体积。根据 MCA-ASPECT 区域评估 FVH 的存在和数量，并分析其与 MR 体积、梗死形态、再通状态、白质病变和出血性转化以及中风严重程度（NIHSS）、中风病因和溶栓率的关系。
75 例（89.3%）患者可检测到 FVH。FVH 的中位数为 4 个（IQR 2-7）。FVH＞4 的患者 NIHSS 评分更高（p=0.021），初始 DWI 病变更大（p=0.008），灌注缺损更大（p=0.001），不匹配体积/比例更大（p=0.005）。这些患者的最终梗死体积更大（p=0.005），出血性转化更常见（p=0.029）。
FVH 的存在表明脑实质中存在更大的缺血区域，主要是由前循环近端血管闭塞引起的。FVH 数量较多可能是初始缺血不匹配和中风严重程度的另一个替代标志物。
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