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Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus

Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to... This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1388v1 ajnr.A1388v2 30/3/564 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sanossian, N. Articles by Liebeskind, D.S. Search for Related Content PubMed PubMed Citation Articles by Sanossian, N. Articles by Liebeskind, D.S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:564-568, March 2009 © 2009 American Society of Neuroradiology BRAIN Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus N. Sanossian a , J.L. Saver b , J.R. Alger b , D. Kim b , G.R. Duckwiler b , R. Jahan b , F. Vinuela b , B. Ovbiagele b and D.S. Liebeskind b a Stroke Center and Department of Neurology, University of Southern California, Los Angeles, Calif b University of California, Los Angeles Stroke Center, Los Angeles, Calif Please address correspondence to Nerses Sanossian, MD, Stroke Center and Department of Neurology, University of Southern California, LAC+USC Medical Center, 1200 N State St, #5640, Los Angeles, CA 90033; e-mail: nsanossian@mednet.ucla.edu BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are commonly encountered on MR imaging studies performed shortly after the onset of acute ischemic stroke. Prior reports have speculated regarding the pathogenesis of this finding, yet definitive correlative angiographic studies have not been performed. We studied the pathophysiologic and hemodynamic correlates of FVH on conventional angiography and concurrent MR imaging sequences. MATERIALS AND METHODS: Retrospective review of FLAIR and gradient-refocused echo MR imaging sequences acquired immediately before conventional angiography for acute stroke was conducted in a blinded fashion. The presence, location, and morphology of FVH were noted and correlated with markers of thrombotic occlusion and collateral flow on angiography. Angiographic collaterals were graded on a 5-point scale incorporating extent and hemodynamic aspects. RESULTS: A prospective ischemic stroke registry of 632 patients was searched to identify 74 patients (mean age, 63.4 ± 20 years; 48% women) having undergone FLAIR sequences immediately before angiography. Median time from FLAIR to angiography was 2.9 hours (interquartile range, 1.1–4.7 hours). FVH were present in 53/74 (72%) of all acute stroke cases with subsequent angiography. FVH distal to an arterial occlusion were associated with a high grade of leptomeningeal collateral blood flow. CONCLUSIONS: FVH are observed in areas of blood flow proximal and distal to stenosis or occlusion and are noted with more extensive collateral circulation. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1388
Publisher site
See Article on Publisher Site

Abstract

This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1388v1 ajnr.A1388v2 30/3/564 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sanossian, N. Articles by Liebeskind, D.S. Search for Related Content PubMed PubMed Citation Articles by Sanossian, N. Articles by Liebeskind, D.S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:564-568, March 2009 © 2009 American Society of Neuroradiology BRAIN Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus N. Sanossian a , J.L. Saver b , J.R. Alger b , D. Kim b , G.R. Duckwiler b , R. Jahan b , F. Vinuela b , B. Ovbiagele b and D.S. Liebeskind b a Stroke Center and Department of Neurology, University of Southern California, Los Angeles, Calif b University of California, Los Angeles Stroke Center, Los Angeles, Calif Please address correspondence to Nerses Sanossian, MD, Stroke Center and Department of Neurology, University of Southern California, LAC+USC Medical Center, 1200 N State St, #5640, Los Angeles, CA 90033; e-mail: nsanossian@mednet.ucla.edu BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are commonly encountered on MR imaging studies performed shortly after the onset of acute ischemic stroke. Prior reports have speculated regarding the pathogenesis of this finding, yet definitive correlative angiographic studies have not been performed. We studied the pathophysiologic and hemodynamic correlates of FVH on conventional angiography and concurrent MR imaging sequences. MATERIALS AND METHODS: Retrospective review of FLAIR and gradient-refocused echo MR imaging sequences acquired immediately before conventional angiography for acute stroke was conducted in a blinded fashion. The presence, location, and morphology of FVH were noted and correlated with markers of thrombotic occlusion and collateral flow on angiography. Angiographic collaterals were graded on a 5-point scale incorporating extent and hemodynamic aspects. RESULTS: A prospective ischemic stroke registry of 632 patients was searched to identify 74 patients (mean age, 63.4 ± 20 years; 48% women) having undergone FLAIR sequences immediately before angiography. Median time from FLAIR to angiography was 2.9 hours (interquartile range, 1.1–4.7 hours). FVH were present in 53/74 (72%) of all acute stroke cases with subsequent angiography. FVH distal to an arterial occlusion were associated with a high grade of leptomeningeal collateral blood flow. CONCLUSIONS: FVH are observed in areas of blood flow proximal and distal to stenosis or occlusion and are noted with more extensive collateral circulation. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Mar 1, 2009

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