scholarly journals Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

2021 ◽  
Vol 13 ◽  
Author(s):  
Lichuan Zeng ◽  
Jinxin Chen ◽  
Huaqiang Liao ◽  
Qu Wang ◽  
Mingguo Xie ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Cerebrovascular Diseases ◽  
Inversion Recovery ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Severe Stenosis ◽  
Vessel Occlusion ◽  
Retrograde Filling ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack

Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.

Abstract 176: The Feasibility of Intravenous Flat-Detector CT (IV FDCT) Angiography for Intracranial Arterial Stenosis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Seung Sheen ◽  
Jin Sue Jeon ◽  
Jeong Eun Kim ◽  
Jae Seung Bang ◽  
Young-Je Son
Keyword(s):  
Arterial Stenosis ◽  
Rank Test ◽  
Digital Subtraction ◽  
Intracranial Arterial Stenosis ◽  
Severe Stenosis ◽  
Flat Detector ◽  
Feasible Alternative ◽  
Intracranial Arteries ◽  
The Difference ◽  
Ischemic Attack

BACKGROUND AND PURPOSE: Intravenous flat-detector CT (IV FDCT) angiography is an emerging technology for the detection of intracranial vascular disease. The study was conducted to determine the feasibility of IV FDCT in estimating major atherosclerotic intracranial arteries stenosis with digital subtraction angiography (DSA) as the reference. METHODS: DSA and IV FDCT were performed simultaneously in patients with transient ischemic attack or acute cerebral infarction. The degree and length of stenosis were measured. The stenotic vessels were categorized into four groups by the grade of stenosis: normal (<30%), mild (30-49%), moderate (50-69%) or severe (>70%). The vessels of the normal group were excluded from analysis to reduce spectrum bias. Measurement of vessels was recorded using an electric ruler by a qualified endovascular neurosurgeon and a neuroradiologist. RESULTS: A total of sixty-nine patients with 842 vessel segments were calculated. Mild (n=56), moderate (n=47) and severe stenosis (n=46) groups were analyzed. IV FDCT had a sensitivity of 97.6%, specificity of 96.9%, and a negative predictive value of 96.9% for detecting ≥50% stenosis and respective values of 91.9%, 98.2%, and 97.4 % for depicting ≥70% stenosis. The difference of stenotic length between two tests was not significantly difference as an increase in the severity of stenosis (Spearman’s rank test; r = - 0.12, p=0.13) CONCLUSION: IV FDCT can be a feasible alternative as a noninvasive method for evaluating stenosis of the major intracranial arteries.

scholarly journals Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack within the Anterior Circulation

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Bei Ding ◽  
Yong Chen ◽  
Hong Jiang ◽  
Huan Zhang ◽  
Juan Huang ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Inversion Recovery ◽  
Arterial Stenosis ◽  
Significant Difference ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack ◽  
Positive Groups

Purpose. The aim of the present study was to evaluate the relationship of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) with haemodynamic abnormality and severity of arterial stenosis in patients with transient ischemic attack (TIA) of the carotid artery system. Patients and Methods. Consecutive inpatients (N = 38) diagnosed with TIAs of the carotid system in a 4-year period (2014–2017) were retrospectively analysed in our study and divided into FVH-negative and FVH-positive groups based on the presence of FVH sign. Each inpatient had undergone magnetic resonance imaging (MRI) followed by computed tomography (CT) perfusion imaging studies. We investigated the degree of arterial stenosis, number of stenosis, watershed regions, and related CT perfusion indexes, including hypoperfusion regions, mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). Spearman rank correlation was performed between FVHs score, the degree of arterial stenosis, and CT perfusion indexes with significant difference. Results. Thirty-one patients (81.6%) observed with FVH sign were assigned to the FVH-positive group. The hypoperfusion regions, MTT, and CBF values were significantly different between the FVH-negative group and FVH-positive groups. Spearman correlation analysis showed significant positive correlations between hypoperfusion regions, MTT, and FVHs scores (r = 0.755 and 0.674, respectively, p<0.01); a moderate negative correlation was found between CBF and FVHs scores (r = −0.525, p<0.01), whereas the degree of artery stenosis revealed no significant correlation with FVH scores (r = 0.253, p>0.05). Conclusion. Hyperintense vessels on FLAIR were closely associated with hypoperfused regions, MTT, and CBF values, which indicated that the presence of FVHs could be an important and convenient imaging marker of haemodynamic impairment in patients with TIA.

Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Linxin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Angiography ◽  
Interobserver Agreement ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Difference ◽  
Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

Abstract WP49: Distal Hyperintense Vessels Were not a Predictor of Large Vessel Occlusion in Patients With Transient Ischemic Attack

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Marcelo M de Figueiredo ◽  
Marcela R Vazzoller ◽  
Edson Amaro Jr ◽  
Renata A Miranda ◽  
Gisele S Silva
Keyword(s):  
Transient Ischemic Attack ◽  
Surrogate Marker ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Information ◽  
Large Vessel ◽  
Arterial Stenosis ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ischemic Attack

Introduction: Distal hyperintense vessels (DHV) detected by FLAIR imaging are not uncommon in patients with acute ischemic stroke. The presence of DHV and its predictors has been scarcely evaluated in patients with transient ischemic attack (TIA), being associated to the presence of large vessel occlusion in such patients. We assessed the hypothesis that DHV are frequent in patients with TIA and do correlate with relevant clinical and neuroimaging characteristics. Methods: We evaluated a database of consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranial vascular imaging. We analyzed the relationship between DHV, clinical presentation, risk factors, neuroimaging characteristics and large artery stenosis or occlusion. DHV signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of DHV. Results: Seventy-two TIA patients were enrolled. The median time from symptoms onset to MRI was 8:39 h [4:21, 14:13]. DHV signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with DHV had more atrial fibrillation (AF) than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (CHF) (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenosis, cerebral microbleeds and white matter abnormalities in patients with and without DHV. In a multivariate logistic regression analysis, only AF had a trend to be a predictor of DHV (OR=4.24, p=0.1). The statistical model to predict DHV including AF, diabetes, and CHF had a moderate fit in terms of discrimination (c statistic=0.62) Conclusion: DHV signals on FLAIR images occur in patients with TIA and might correlate with clinical variables like AF and not only with large vessel occlusion as previously described. The presence of DVH in patients with TIA and AF might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Patients with Transient Ischemic Attack

2017 ◽  
Vol 26 (10) ◽  
pp. 2412-2415 ◽  
Author(s):  
Marcelo Marinho de Figueiredo ◽  
Edson Amaro Júnior ◽  
Maramélia Araújo de Miranda Alves ◽  
Marcela Vazzoler ◽  
Renata Carolina Acre Nunes Miranda ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Inversion Recovery ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack

scholarly journals Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

Stroke ◽  
2013 ◽  
Vol 44 (6) ◽  
pp. 1635-1640 ◽  
Author(s):  
Junpei Kobayashi ◽  
Toshiyuki Uehara ◽  
Kazunori Toyoda ◽  
Kaoru Endo ◽  
Tomoyuki Ohara ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Transient Ischemic Attack ◽  
Inversion Recovery ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack

scholarly journals Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Lars Wessels ◽  
Nils Hecht ◽  
Peter Vajkoczy
Keyword(s):  
Cerebrovascular Disease ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Multivessel Disease ◽  
Vessel Occlusion ◽  
Ischemic Attack

Background and Purpose: Despite the findings reported in the COSS (Carotid Occlusion Surgery Study), patients with atherosclerotic cerebrovascular disease continue to be referred for superficial temporal artery to middle cerebral artery bypass surgery. Here, we determined how today’s patients differ from the population reported in COSS. Methods: We retrospectively analyzed all patients that were referred to our Department for superficial temporal artery to middle cerebral artery bypass surgery of atherosclerotic cerebrovascular disease following the publication of COSS. Results: Between 2012 and 2019, 179 patients were referred for 186 bypass surgeries. Ninety-one (51%) patients suffered atherosclerotic, unilateral internal carotid occlusion and 88 (49%) atherosclerotic multivessel disease. All patients had received intensive medical management. A single transitory ischemic attack or ischemic stroke within the last 120 days according to the inclusion criteria of COSS occurred in only 36 out of 179 (20%) patients, whereas 27 out of 179 (15%) suffered >1 transitory ischemic attack within 120 days, 109 out of 179 (61%) had recurrent minor ischemic stroke, and 7 out of 179 (4%) were hemodynamically unstable and required blood pressure maintenance. The distribution of symptoms did not differ between atherosclerotic unilateral internal carotid artery occlusion and atherosclerotic multivessel disease ( P =0.376) but hemodynamic impairment was significantly greater in atherosclerotic multivessel disease ( P <0.001 for atherosclerotic multivessel disease versus atherosclerotic unilateral internal carotid artery occlusion). The overall perioperative stroke rate was 4.3%. Conclusions: Patients referred for flow augmentation surgery today appear to suffer more severe symptoms and vessel occlusion patterns than patients reported in COSS. A new, carefully designed randomized controlled trial appears warranted, considering the still poor prognosis of severe atherosclerotic cerebrovascular disease.

scholarly journals Juxtacortical Spots on Fluid-Attenuated Inversion Recovery Images in Cryptogenic Transient Ischemic Attack

2013 ◽  
Vol 9 (2) ◽  
pp. 103 ◽  
Author(s):  
Dong-Eun Kim ◽  
Min-Ji Choi ◽  
Joon-Tae Kim ◽  
Jane Chang ◽  
Seong-Min Choi ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Inversion Recovery ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Attack

scholarly journals Pregnancy Risk Factors as Predictors of Offspring Cerebrovascular Disease

Stroke ◽  
2021 ◽  
Vol 52 (4) ◽  
pp. 1347-1354
Author(s):  
Milja Kivelä ◽  
Ina Rissanen ◽  
Eero Kajantie ◽  
Hilkka Ijäs ◽  
Harri Rusanen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Transient Ischemic Attack ◽  
Cerebrovascular Diseases ◽  
Normal Weight ◽  
Birth Complications ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Pregnancy And Birth

Background and Purpose: For prevention of cerebrovascular diseases, it is important to understand the risk factors occurring early in life. The aim was to investigate the relationship of maternal and offspring anthropometrics and pregnancy complications with offspring’s risk of ischemic and hemorrhagic stroke and transient ischemic attack in adulthood. Methods: Within the population-based prospective Northern Finland Birth Cohort 1966, 11 991 persons were followed from early pregnancy to 52 years of age. Information on pregnancy and birth complications were collected starting between 24th and 28th gestational week and at birth. Ischemic and hemorrhagic strokes of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of pregnancy and birth complications with incidence of cerebrovascular disease in the offspring, with adjustments for sex, family socioeconomic status, mother’s age, and smoking during pregnancy. Results: During 568 821 person-years of follow-up, 453 (3.8%) of the offspring had a stroke or transient ischemic attack. Small and large gestational weight gain among normal weight mothers were associated with increased ischemic stroke risk in offspring (adjusted hazard ratio [aHR], 1.93 [95% CI, 1.28–2.90] and aHR, 1.54 [95% CI, 1.02–2.31], respectively). Small birth weight for gestational age and small ponderal index were associated with increased risk for ischemic stroke (aHR, 1.95 [CI, 1.21–3.13] and aHR, 1.36 [CI, 1.04–1.77], respectively). Threatening miscarriage was also associated with increased risk of any stroke (aHR, 1.64 [CI 1.14–2.37]). Maternal smoking, hypertension, or birth complications were not associated with increased risk of cerebrovascular disease in the offspring. Conclusions: The results of this study suggest that disturbances in maternal and fetal growth during pregnancy may predispose offspring to developing cerebrovascular diseases in adulthood.

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