Abstract
Background
Multiple methods have been used to analyze fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) which may represent collaterals in patients with acute ischemic stroke (AIS); however, there is no consensus between methods.
Purpose
To compare three frequently used FVH methods for predicting early infarct volume and clinical outcome in patients with AIS.
Material and Methods
Patients with AIS in middle cerebral artery territory were recruited. FVHs were evaluated using extensive FVHs, FVH-diffusion-weighted imaging (DWI) mismatch, and FVH-in/out-DWI. Infarct volume at baseline and day 7 were measured. Early neurological improvement (ENI) was assessed. Good outcomes were defined by modified Rankin Scale scores of 0–2 at 90 days.
Results
Fifty-one patients were included. ENI was 55.6% in patients with extensive FVHs and 23.3% in those without (P = 0.024). Patients with extensive FVHs had smaller infarct volume growth at seven days than those without (P = 0.041). ENI was 48.3% in patients with FVH-DWI mismatch and 15.8% in those without (P = 0.021). Patients with FVH-DWI mismatch had smaller infarct volumes at seven days than those without (P = 0.038). Patients with FVH-out-DWI had smaller baseline infarct volumes, smaller seven-day volumes, and smaller infarct growth than those with FVH-in-DWI (P<0.001, P<0.001, and P = 0.031, respectively). In multivariate logistic regression analysis, the infarct growth at seven days negatively independently predicted ENI (OR = 0.737, 95% CI 0.593–0.915, P = 0.006). However, none of the FVH classifications could predict a good 90-day outcome.
Conclusion
Patients with extensive FVHs or FVH-DWI mismatch tend to have early favorable clinical outcome. FVH-out-DWI being associated with smaller infarct growth may also indicate early favorable clinical outcome.
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