Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis
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ORIGINAL ARTICLE
Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis W. J. Shang 1 & L. M. Shu 1,2 & X. Zhou 3 & H. Q. Liao 2 & X. H. Chen 1 & H. Hong 1 & H. B. Chen 1 Received: 5 February 2020 / Accepted: 11 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Purpose The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time. Methods We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0–2 and 3–6. Symptom-to-MRI time was divided into two categories: ≤ 14 days and ≥ 15 days. Results We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14 days (P = 0.008), but not in those with symptom-to-MRI times ≥15 days (P = 0.61). In the group with symptom-toMRI times ≤14 days, patients with LA 3–6 and FVH(+) (OR, 3.044; 95% CI, 1.116–8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0–2 and FVH(+) but not compared with those with LA 0–2 and FVH(−) or LA 3–6 and FVH(−). In addition, FVH location did not influence the relationship between FVH and outcomes. Conclusions The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA. Keywords Ischaemic stroke . FLAIR vascular hyperintensity . Magnetic resonance imaging . Leukoaraiosis
Introduction In the context of stroke and steno-occlusive diseases, fluidattenuated inversion recovery vascular hyperintensity (FVH) is related to stationary blood and slow antegrade and retrograde collateral circulation [1–4]. Hence, FVH is an easily W. J. Shang and L. M. Shu contributed equally to this work. * H. B. Chen [email protected] 1
Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, Guangdong Province, China
2
Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, NO. 628 Zhenyuan Road, Shenzhen 518107, China
3
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, No. 2nd Zhongshan Road, Guangzhou 510080, China
detectable marker of impaired haemodynamics. However, despite extensive study on its association with stroke outcome, the prognostic value of FVH remains controversial. Some studi
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