Hyperintense Vessels on T2-PROPELLER-FLAIR in Patients with Acute MCA Stroke: Prediction of Arterial Stenosis and Perfusion Abnormality

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Fig 1.
The distribution of FHVs and perfusion abnormality in each MCA-ASPECTS territory. The black, gray, and dotted bars represent the frequency of FHVs and perfusion abnormality for T2-FLAIR, T2-PROPELLER-FLAIR, and T_max, respectively.
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Fig 2.
A 63-year-old man with right MCA territory infarction. FHVs on T2-FLAIR at the level of the basal ganglia (A) were not seen, whereas FHVs on T2-PROPELLER-FLAIR (B) were seen in the Sylvian fissure, M1, M2, and M3 (dotted circle). On the T_max map (C), FHVs were well-matched with perfusion abnormality. FHVs on T2-FLAIR at the level of the ventricle above the basal ganglia (D) were seen in the M5 and M6 territory (arrow), whereas FHVs on T2-PROPELLER-FLAIR (E) were seen in all territories (dotted circle). On T_max (F), FHVs on T2-PROPELLER-FLAIR were well-matched with perfusion abnormality.

Table 1:

Characteristics and MRA findings of study patients^{^a}

Features
No. of patients	35
Age (yr) (mean)	65.1
Female sex	12/35 (34)
Hypertension	15/35 (42)
Diabetes mellitus	11/35 (31)
Median time interval from symptom onset to MRI (hr) (IQR)	23.4 (9.62–57.5)
MRA findings
Large-artery stenosis or occlusion^{^b}	28/35 (80)
MCA horizontal segment	12 (34)
MCA insular segment	5 (15)
MCA cortical segment	1 (3)
Distal ICA	3 (8)
Proximal ICA	7 (20)
Negative	7 (20)

Note:—IQR indicates interquartile range.
↵a Unless otherwise specified, data are the number of patients, with percentages in parentheses.
↵b Represents ≥50% stenosis or occlusion of the large artery.

Table 2:

Comparison of FHVs and parenchymal ischemic lesions between T2-FLAIR and T2-PROPELLER-FLAIR^{^a}

	T2-FLAIR	T2-PROPELLER-FLAIR	P Value
FHVs
FHV score	1.21 ± 1.47	3.50 ± 2.79	<.01
Parenchymal ischemic lesions
CNR	20.93 ± 8.61	8.43 ± 3.51	<.01
Sensitivity^{^b}	148/153 (96.7)	149/153 (97.4)	1.00

Note:—CNR indicates contrast-to-noise ratio: (SI_lesion − SI_WM) / SD_n.
↵a FHV scores were defined by counting the number of MCA-ASPECTS territories in which FHVs were present.
↵b Sensitivity for the detection of acute and old ischemic lesions. Data are the number of ischemic lesions and percentages.

Table 3:

The predictability of FHVs for large-artery stenosis on T2-FLAIR and T2-PROPELLER-FLAIR^{^a}

	T2-FLAIR	T2-PROPELLER-FLAIR	P Value
Arterial stenosis or occlusion on MRA	28/35 (80%)
Incidence of FHV	19/35 (54%)	26/35 (74%)	.06
Predictability^{^b}
True-positive	19	26
True-negative	7	7
False-positive	0	0
False-negative	9	2
Sensitivity	68%	93%	.03
Specificity	100%	100%

↵a Data are the number of patients and percentages.
↵b Represents the diagnostic value for the prediction of large-artery stenosis or occlusion.

Table 4:

Associations among FHV scores, ischemic lesion volume, and perfusion abnormality volume in 9 patients with MCA horizontal segment occlusion

	Ischemic DWI Lesion Volume (r)^{^a}	Perfusion Abnormality Volume (r)^{^a}
Median (IQR) (mL)	4.74 (1.76–11.57)	64.91 (60.33–70.31)
FHV scores on T2-FLAIR	0.86, 0.01	0.28, 0.43
FHV scores on T2-PROPELLER-FLAIR	0.38, 0.34	0.79, 0.02
FHV mismatch^{^b}	−0.79, 0.01	0.33, 0.42

↵a r closer to 1 represents a positive correlation. r closer to −1 represents a negative correlation.
↵b Calculated by (FHV scores on T2-PROPELLER-FLAIR − FHV scores on T2-FLAIR) / FHV scores on T2-PROPELLER-FLAIR.