FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion.
FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion.
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DOI：
10.1111/jon.12274
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Rost NS
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文献类型：
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作者：
Karadeli HH;Giurgiutiu DV;Cloonan L;Fitzpatrick K;Kanakis A;Ozcan ME;Schwamm LH;Rost NS
液体衰减反转恢复(FLAIR)血管高信号(FvH)是在急性缺血性卒中(AIS)患者中发现的一种新的放射学标志物，与血流缓慢和潜在的可挽救脑组织有关。伴有近端动脉闭塞(PAO)的AIS患者的软脑膜侧支状态较差与较大的最终梗塞和较差的临床预后相关，这也受白质高强度(WMH)严重程度的影响。我们试图评估FvH作为AIS患者急性侧支血管状态的标志及其与WMH负荷的相关性。连续行基线CT血管造影术(CTA)的AIS患者是从前瞻性数据库中回顾选择的。静脉注射组织型纤溶酶原激活剂(IVtPA)后即刻行MRI检查，根据FVH的部位、程度和入院时的评分进行分级。在入院CTA时对软脑膜侧支循环血流分级进行排序。WMH容量(WMHV)使用有效的容量方案进行评估。分析FVH、侧支循环分级与WMHV的关系。在39名患者(平均年龄70.5±12.7岁；56%女性，美国国立卫生研究院卒中评分(NIHSS)平均17.2(±4.4)分)中，WMHV中位数为6.0cm3。FVH评分与侧支循环分级显著相关(Spearman‘sρ=0.41p=0.009)。在单因素回归模型中，FVH程度与WMHV呈负相关(β=−为0.33p=0.04)。急性MRI检测的FvH评分可作为AIS患者侧支循环分级的指标。FVH程度与WMHV呈负相关，提示重度脑白质疏松症患者可能存在弥漫性脑血管病变。
Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is a novel radiographic marker detected in acute ischemic stroke (AIS) patients, which is linked to slow blood flow and potentially salvageable brain tissue. Poor leptomeningeal collateral status in AIS patients with proximal artery occlusion (PAO) is associated with larger final infarct and worse clinical outcomes, which are also affected by severity of white matter hyperintensity (WMH). We sought to evaluate FVH utility as a marker of acute collateral vessel status and its association with WMH burden in AIS patients. Consecutive AIS patients with PAO on baseline CT angiography (CTA) were retrospectively selected from a prospectively-derived database. FVH was graded by its location, degree, and score on admission MRI obtained immediately after intravenous tissue plasminogen activator (IV tPA) administration. Leptomeningeal collateral flow grade was ranked on admission CTA. WMH volume (WMHV) was assessed using a validated volumetric protocol. Relationship between FVH, collateral flow grade, and WMHV were analyzed. Among 39 patients (mean age 70.5±12.7 years; 56% women, mean National Institutes of Health Stroke Scale (NIHSS) score 17.2 (±4.4)), median WMHV was 6.0 cm3. FVH score and collateral flow grade were significantly correlated (Spearman's ρ=0.41, p= 0.009). In a univariate regression model, FVH degree was inversely associated with WMHV (β=−0.33 p=0.04). FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in AIS patients. FVH degree is inversely associated with WMHV, possibly signifying diffuse disease of cerebral vasculature in patients with severe leukoaraiosis.