J Korean Neurol Assoc.  2011 Nov;29(4):309-316.

Hyperintense Vessel Signs on FLAIR MRI as a Predictor of Early Neurological Deterioration in Patients with Acute Posterior Circulation Infarction

• Kim DE
• Kim JT
• Cho BH
• Lee SY
• Choi KH
• Park MS
• Cho KH

Abstract

BACKGROUND
Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery imaging (FLAIR) is an indicator of slow flow and early ischemia. This study tested the hypothesis that HVS in the posterior circulation is associated with a worse outcome.
METHODS
We retrospectively included 64 stroke patients with posterior circulation steno-occlusion within 6 hours of symptom onset and reviewed early neurological deterioration (END). END was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score of 4 or more from baseline during the first week. We analyzed demographic and laboratory information followed by an assessment of the magnetic resonance images. In addition, we assessed the posterior circulation Albert Stroke Program Early CT Score (pc-ASPECTS) on diffusion-weighted imaging (DWI).
RESULTS
Among the 64 patients who met the inclusion criteria, END was seen in 17 patients. On univariate analysis, these END patients had higher baseline NIHSS scores and elevated initial systolic blood pressure (iSBP). Multiple logistic regression analysis revealed pc-ASPECTS (p=0.007), HVS on FLAIR (p=0.011), and iSBP (p=0.016) as independent predictors of END.
CONCLUSIONS
The presence of HVS on FLAIR in the posterior circulation might indicate the presence of more severe ischemic penumbrae and END. pc-ASPECTS may also be an independent predictor of functional outcome.

Keyword

Fluid-attenuated inversion recovery imaging (FLAIR); Early neurological deterioration (END); Posterior circulation infarction; Albert Stroke Program Early CT Score (ASPECTS)

MeSH Terms

Blood Pressure
Glycosaminoglycans
Humans
Infarction
Ischemia
Logistic Models
Magnetic Resonance Spectroscopy
National Institutes of Health (U.S.)
Retrospective Studies
Stroke
Glycosaminoglycans