Gawlitza M, Quäschling U, Hobohm C, Otto J, Voigt P, Hoffmann K-T, Lobsien D
From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.)Diagnostic and Interventional Radiology (M.G., J.O., P.V.)
From the Departments of Neuroradiology (M.G., U.Q., K.-T.H., D.L.).
AJNR Am J Neuroradiol. 2014 Aug;35(8):1520-6. doi: 10.3174/ajnr.A3961. Epub 2014 May 8.
FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome.
We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation-ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness.
The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%-95%) but very good specificity (95%-100%) and accuracy (85%-93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen κ, 0.64-0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation-ASPECTS (r = -0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P < .05).
The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival.
已知液体衰减反转恢复序列（FLAIR）高信号血管是半球血管闭塞时侧支血流缓慢的一个征象。此外，它们似乎还具有预后意义。本研究的目的是评估基底动脉的高信号形态（FLAIR高信号基底动脉）作为基底动脉闭塞的标志物以及患者预后的预测指标。
我们回顾性纳入了20例基底动脉闭塞患者，这些患者最初接受了磁共振成像检查，随后进行了数字减影血管造影（DSA）。在病例对照设计中，由4名独立阅片者测试FLAIR高信号基底动脉征象的诊断准确性，并评估FLAIR高信号基底动脉与弥散加权成像（DWI）后循环脑梗死早期CT评分（ASPECTS）、患者预后及患者生存情况之间的关系。为了对FLAIR高信号基底动脉征象范围进行分级，我们通过计算从基底动脉尖至枕骨大孔的层面数（其中血管腔内存在高信号）乘以层面厚度来生成一个分数。
FLAIR高信号基底动脉征象对基底动脉闭塞的检测显示出中等敏感性（65% - 95%），但特异性（95% - 100%）和准确性（85% - 93%）非常好。阅片者间观察到高度或极好的一致性（Cohen κ系数，0.64 - 0.85）。FLAIR高信号基底动脉与后循环ASPECTS呈负相关（r = -0.67，P = 0.01）。FLAIR高信号基底动脉分数越高，与患者死亡相关（28.3 ± 13.7对13.4 ± 11.1，P < 0.05）。
FLAIR高信号基底动脉征象被证明是血管闭塞的一个有价值的标志物，并且可能极大地支持基底动脉闭塞的诊断。已建立的FLAIR高信号基底动脉分数可能有助于预测个体患者的生存情况。
