FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis
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ORIGINAL ARTICLE
FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis Paul Apfaltrer1 · Holger Wenz1 · Johannes Böhme1 · Matthias Gawlitza2 · Christoph Groden1 · Angelika Alonso3 · Alex Förster1 Received: 24 November 2019 / Accepted: 22 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Occlusion or significant stenosis of the internal carotid artery (ICA) in the cervical segment is commonly associated with a poststenotic decrease in the downstream blood flow and perfusion. Fluid attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are a phenomenon that represents slow arterial blood flow. In this study, we investigated the frequency and extent of FVH in the distal ICA in patients with proximal ICA stenosis. Methods We analyzed the magnetic resonance imaging (MRI) findings in 51 patients with a total of 60 cervical ICA stenoses with special focus on the frequency and extent of FVH in the area of the petrous segment of the ICA on FLAIR images and correlated these with Doppler/duplex sonography results. Results In 46 (76.7%) patients with ICA stenosis, FVH could be detected in the petrous segment of the ICA: in 19 (41.3%) patients a thin hyperintense rim near the vessel wall (grade 1), in 24 (52.2%) patients a strong hyperintense rim near the vessel wall (grade 2), and in 3 (6.5%) patients a hyperintense filling of the entire lumen (grade 3) was observed. The extent of FVH in the ICA in the petrous segment showed a high negative correlation with the poststenotic flow velocity (Spearman correlation, R = –0.75, p < 0.001), and moderate correlation with the degree of ICA stenosis (Spearman correlation, R = 0.51, p< 0.001). Conclusion An FVH in the petrous ICA is commonly seen among patients with steno-occlusive disease in proximal ICA and could therefore be useful to recognize a proximal ICA stenosis even on FLAIR images.
Keywords FLAIR vascular hyperintensities · Ischemic stroke · ICA · FVH · Hyperintese vessel sign
Introduction Significant internal carotid artery (ICA) stenosis is a common cause of ischemia in the carotid territory; however, an anatomically significant stenosis does not predict the presence or degree of impaired perfusion in the distal cerebral circulation [1]. Besides the well-established parenchymal hyperintensities in subacute and acute ischemic stroke pa-
Alex Förster
[email protected] 1
Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
2
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
3
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
tients [2], specific vascular findings, such as fluid attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) and the hyperintense vessel sign (HVS) have been described on FLAIR images [3]. They may be caused by steno-occlusive disease [4, 5], intraluminal thrombus or reduced downstream blo
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