Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy?

E. Mahdjoub; G. Turc; L. Legrand; J. Benzakoun; M. Edjlali; P. Seners; S. Charron; W. Ben Hassen; O. Naggara; J.-F. Meder; J.-L. Mas; J.-C. Baron; C. Oppenheim

doi:10.3174/ajnr.A5431

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Fig 1.
Extensive FVHs and low hypoperfusion intensity ratio. MR imaging obtained 110 minutes after stroke onset (NIHSS score = 12) in an 88-year-old woman. A, FVHs in 6 ASPECTS areas (insula, M2–M6), corresponding to a 6-point FVH-score. B, Thirteen-milliliter diffusion-weighted imaging lesion. Tmax map (C) with 85-mL Tmax >6-second lesion and 15-mL Tmax >10-second lesion (D) (HIR = 0.18). After intravenous thrombolysis, the 24-hour NIHSS score was 1, and the DWI lesion was 12 mL (not shown). The 3-month mRS was 1.
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Fig 2.
Few FVHs and high hypoperfusion intensity ratio. MR imaging obtained 180 minutes after stroke onset (NIHSS score = 12) in a 56-year-old man. A, FVHs in the insula, corresponding to a 1-point FVH score. B, Ninety-four milliliter diffusion-weighted imaging lesion. Tmax map (C) with 91-mL Tmax >6-second lesion and 53-mL Tmax >10-second lesion (D) (HIR = 0.58). After intravenous thrombolysis, the 24-hour NIHSS score was 14, and the DWI lesion was 150 mL (not shown). The 3-month mRS was 3.

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Table 1:

Comparison of patients with low and high HIR^{^a}

Characteristics	Low HIR (n = 122)	High HIR (n = 122)	P Value
Age	70 (56–79)	71 (60–79)	.446
Male (No.) (%)	55 (45)	83 (68)	<.001
Hypertension (No.) (%)^{^b}	68 (57)	66 (55)	.685
Diabetes mellitus (No.) (%)^{^b}	12 (10)	20 (17)	.142
Hyperlipidemia (No.) (%)^{^b}	31 (26)	40 (33)	.251
Current smoking (No.) (%)^{^c}	23 (20)	25 (21)	.771
Systolic BP (mm Hg)	149 (139–163)	156 (139–173)	.141
Diastolic BP (mm Hg)	82 (71–89)	81 (70–93)	.990
Serum glucose (mmol/L)^{^d}	6.1 (5.4–7.0)	6.5 (5.5–7.9)	.038
NIHSS^{^b} score	11 (7–17)	16 (11–21)	<.001
Baseline MRI
Onset-to-MRI time (min)	112 (86–153)	112 (84–156)	.838
Proximal occlusion (No.) (%)	81 (66)	80 (66)	.893
DWI₁ volume (mL)	8 (4–19)	41 (16–96)	<.001
Tmax >6-sec volume (mL)	44 (17–85)	115 (56–147)	<.001
Tmax >10-sec volume (mL)	9 (2–22)	52 (27–75)	<.001
PWI-DWI mismatch (No.) (%)	85 (70)	59 (48)	<.001
FVH score (No.) (%)			.016^{^e}
0–1	6 (5)	13 (11)
2–3	30 (25)	33 (27)
4–5	54 (44)	59 (48)
6–7	32 (26)	17 (14)
24-hr follow-up
NIHSS score^{^f}	6 (2–15)	14 (7–20)	<.001
ENI (No.) (%)^{^f}	51 (42)	27 (22)	.001
DWI₂ volume (Ml)	18 (9–45)	87 (33–161)	<.001
Infarct growth (Ml)	6 (1–26)	29 (10–75)	<.001
Complete recanalization (No.) (%)	40 (33)	45 (37)	.502
3-mo mRS ≤ 1 (No.) (%)^{^g}	49 (45)	25 (21)	<.001
3-mo mRS ≤ 2 (No.) (%)^{^g}	63 (58)	51 (44)	.033

Note:—BP indicates blood pressure; ENI, early neurologic improvement.
↵a Unless specified, numbers are median (interquartile range).
↵b Missing data for 4 patients.
↵c Missing data for 9 patients.
↵d Missing data for 13 patients.
↵e P for Trend.
↵f Missing data for 5 patients.
↵g Missing data for 18 patients.

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Table 2:

Factors associated with a low HIR in multivariable analysis

Characteristics	Adjusted OR (95% CI)	P Value
Male	0.98 (0.42–2.29)	.953
Serum glucose, per 1-mmol/L increase^{^a}	0.99 (0.83–1.18)	.882
Baseline NIHSS score, per 1-point increase^{^b}	1.04 (0.96–1.12)	.343
DWI₁ volume, per 1-mL increase	1.01 (0.99–1.03)	.446
Tmax >10-sec volume, per 1-mL increase^{^c}	0.89 (0.85–0.92)	<.001
PWI-DWI mismatch	8.95 (2.65–30.22)	<.001
FVH-score	–	.002^{^d}
0–1	1	–
2–3	1.17 (0.25–5.50)	.844
4–5	2.39 (0.56–10.22)	.242
6–7	34.20 (4.35–268.60)	.001

↵a Missing data for 13 patients.
↵b Missing data for 4 patients.
↵c Tmax >6 sec was not selected with Tmax >10 sec to avoid collinearity.
↵d P for Trend.

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Table 3:

Comparison of patients according to FVH score^{^a}

	FVH Score				P Value
	0–1 (n = 19)	2–3 (n = 63)	4–5 (n = 113)	6–7 (n = 49)	P Value
Age (yr)	73 (60–80)	70 (57–79)	71 (56–80)	67 (62–77)	.339
Male (No.) (%)	12 (63)	31 (49)	68 (60)	27 (55)	.500
Hypertension (No.) (%)^{^b}	12 (63)	38 (60)	58 (51)	26 (53)	.537
Diabetes mellitus (No.) (%)^{^b}	4 (21)	9 (14)	13 (12)	6 (12)	.708
Hyperlipidemia (No.) (%)^{^b}	9 (47)	18 (29)	43 (38)	18 (37)	.477
Current smoking (No.) (%)^{^c}	3 (16)	12 (19)	23 (20)	10 (20)	.954
Systolic BP (mm Hg)	148 (140–172)	159 (142–173)	151 (139–167)	148 (134–160)	.071
Diastolic BP (mm Hg)	87 (76–93)	84 (69–95)	80 (70–89)	80 (72–90)	.334
Serum glucose (mmol/L)^{^d}	6.6 (5.5–8.1)	6.7 (5.4–7.3)	6.4 (5.5–7.6)	6.0 (5.3–7.0)	.189
Baseline NIHSS score^{^b}	13 (8–20)	13 (7–18)	15 (8–20)	15 (11–21)	.321
Onset-to-MRI time (min)	142 (84–196)	115 (89–176)	115 (91–151)	97 (83–130)	.007
Proximal occlusion (No.) (%)	6 (31)	31 (49)	81 (72)	43 (88)	<.001
DWI₁ volume (mL)	24 (12–102)	19 (5–67)	18 (7–49)	12 (6–34)	.077
Tmax >10-sec volume (mL)	26 (5–76)	17 (4–43)	24 (11–53)	30 (11–64)	.200
Tmax >6-sec volume (mL)	65 (19–133)	47 (19–102)	78 (40–123)	96 (66–134)	.002
HIR ≤ 0.35 (No.) (%)	6 (32)	30 (48)	54 (47)	32 (65)	.057
HIR	0.44 (0.30–0.54)	0.39 (0.19–0.48)	0.33 (0.19–0.47)	0.32 (0.14–0.44)	.049
PWI-DWI mismatch (No.) (%)	6 (32)	32 (51)	71 (63)	35 (51)	.011
DWI₂ volume (mL)	73 (14–150)	43 (13–147)	37 (13–104)	29 (12–52)	.075
24-hr infarct growth (mL)	27 (2–87)	19 (4–57)	14 (1–45)	13 (4–28)	.125
Complete recanalization (No.) (%)	7 (37)	19 (30)	38 (34)	21 (43)	.551
ENI (No.) (%)^{^e}	7 (37)	12 (20)	30 (27)	29 (53)	<.001
3-mo mRS ≤ 1 (No.) (%)^{^f}	3 (17)	14 (24)	35 (34)	22 (45)	.039
3-mo mRS ≤ 2 (No.) (%)^{^f}	9 (47)	26 (41)	47 (42)	32 (65)	.057