The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset

W.J. Shang; H.B. Chen; L.M. Shu; H.Q. Liao; X.Y. Huang; S. Xiao; H. Hong

doi:10.3174/ajnr.A6142

Abstract

BACKGROUND AND PURPOSE: FLAIR vascular hyperintensity has been recognized as a marker of collaterals in ischemic stroke, but the impact on outcome is still controversial. We hypothesized that the association between FLAIR vascular hyperintensity and outcome varies with time.

MATERIALS AND METHODS: We included 459 consecutive patients with middle cerebral artery stroke and divided them into 3 groups by symptom-to-MR imaging time (group 1, ≤7 days; group 2, 8–14 days; group 3, ≥15 days). The FLAIR vascular hyperintensity score, ranging from 0 to 3 points, was based on territory distributions of different MCA segments. The associations between FLAIR vascular hyperintensity and outcome with time were analyzed qualitatively and quantitatively.

RESULTS: No patients underwent MR imaging within 6 hours of onset. The proportion of FLAIR vascular hyperintensity (+) and severe stenosis or occlusion of MCA was not significantly dependent on time. In groups 1 and 2, FLAIR vascular hyperintensity (+) was significantly associated with larger lesions, the prevalence of flow injury, and unfavorable outcome (mRS ≥ 2). There were no such associations in group 3. Multiple logistic regressions demonstrated that FLAIR vascular hyperintensity (+) was an independent risk factor for unfavorable outcome in group 2. Infarction volume tended to increase with the increase of the distal FLAIR vascular hyperintensity score in groups 1 and 2, while declining in group 3.

CONCLUSIONS: FLAIR vascular hyperintensity is associated with unfavorable outcome within 6 hours to 14 days of onset, while the wider distribution of distal FLAIR vascular hyperintensity may be favorable beyond 14 days of onset in MCA infarction. Symptom-to-MR imaging time should be considered when assessing the prognostic value of FLAIR vascular hyperintensity.

ABBREVIATION:

FVH: FLAIR vascular hyperintensity

Footnotes

W.J. Shang and H.B. Chen contributed to the work equally.
Disclosures: Wenjin Shang—RELATED: Grant: National Natural Science Foundation of China (No. 81671134); Medical Scientific Research Foundation of Guangdong Province of China (No. A2017219); Guangzhou Science and Technology Programme (No. 2014Y2–00502), Comments: My institution is supported by the grants from Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (No. 2017B030314103); Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases (No. 2015B050501003); Guangdong Provincial Engineering Center for Major Neurological Disease Treatment; Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease. Liming M. Shu—RELATED: Grant: National Natural Science Foundation of China (No. 81671134); Medical Scientific Research Foundation of Guangdong Province of China (No. A2017219); Guangzhou Science and Technology Programme (No. 2014Y2–00502).* Su Xiao—RELATED: Grant: Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (No. 2017B030314103); Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases (No. 2015B050501003); Guangdong Provincial Engineering Center for Major Neurological Disease Treatment; Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease.* Hua Hong—RELATED: Grant: National Natural Science Foundation of China (No. 81671134); Medical Scientific Research Foundation of Guangdong Province of China (No. A2017219); Guangzhou Science and Technology Programme (No. 2014Y2–00502), Comments: Our institution is supported by the grants from Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (No. 2017B030314103); Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases (No. 2015B050501003); Guangdong Provincial Engineering Center for Major Neurological Disease Treatment; Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease; Others: We paid money to Editage, a division of Cactus Communications, for English editing to ensure that the language is clear and free of errors. The intent of our message was not altered in any way during the editing process. *Money paid to institution.
The study was supported by grants from: National Natural Science Foundation of China (No. 81671134); Medical Scientific Research Foundation of Guangdong Province of China (No. A2017219); Guangzhou Science and Technology Programme (No. 2014Y2-00502); Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (No. 2017B030314103); Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases (No. 2015B050501003); Guangdong Provincial Engineering Center for Major Neurological Disease Treatment; and Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease.