Top

Neuroradiology

Published in:

01-08-2017 | Interventional Neuroradiology

Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting

Authors: Chih-Cheng Wan, David Yen-Ting Chen, Ying-Chi Tseng, Feng-Xian Yan, Kun-Yu Lee, Chen-Hua Chiang, Chi-Jen Chen

Published in: Neuroradiology | Issue 8/2017

Abstract

Purpose

No reliable imaging sign predicting cerebral hyperperfusion after intracranial arterial stenting (IAS) had been described in the literature. This study evaluated the effect of fluid-attenuated inversion recovery vascular hyperintensities (FVHs), also called hyperintense vessel sign on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MR images, in predicting significant increase in cerebral blood flow (CBF) defined by arterial spin labeling (ASL) after IAS.

Methods

We reviewed ASL CBF images and T2-FLAIR MR images before (D0), 1 day after (D1), and 3 days after (D3) IAS of 16 patients. T1-weighted MR images were used as cerebral maps for calculating CBF. The changes in CBF values after IAS were calculated in and compared among stenting and nonstenting vascular territories. An increase more than 50% of CBF was considered as hyperperfusion. The effect of FVHs in predicting hyperperfusion was calculated.

Results

The D1 CBF value was significantly higher than the D0 CBF value in stenting vascular, contralateral anterior cerebral artery, contralateral middle cerebral artery, and contralateral posterior cerebral artery (PCA) territories (all P < .05). The D1 and D3 CBF values were significantly higher than the D0 CBF value in overall vascular (P < .001), overall nonstenting vascular (P < .001), and ipsilateral PCA (P < .05) territories. The rate of more than 50% increases in CBF was significantly higher in patients who exhibited asymmetric FVHs than in those who did not exhibit these findings.

Conclusion

FVHs could be a critical predictor of a significant increase in CBF after IAS.

Wong LKS (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159CrossRefPubMed

Huang YN, Gao S, Li SW, Li JF, Wong KS, Kay R (1997) Vascular lesions in Chinese patients with transient ischemic attacks. Neurology 48:524–525CrossRefPubMed

Liu H-M, Tu Y-K, Yip P-K, Su C-T (1996) Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan Chinese patients with MR angiography: preliminary experience. Stroke 27:650–653CrossRefPubMed

Caplan LR, Gorelick PB, Hier DB (1986) Race, sex and occlusive cerebrovascular disease: a review. Stroke 17:648–655CrossRefPubMed

Nishimaru K, McHenry LC, Toole JF (1984) Cerebral angiographic and clinical differences in carotid system transient ischemic attacks between American Caucasian and Japanese patients. Stroke 15:56–59CrossRefPubMed

van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA et al (2005) Cerebral hyperperfusion syndrome. The Lancet Neurology 4:877–888CrossRefPubMed

Xu S, Wu P, Shi H, Ji Z, Dai J (2014) Hyperperfusion syndrome after stenting for intracranial artery stenosis. Cell Biochem Biophys 71:1537–1542CrossRef

Azizyan A, Sanossian N, Mogensen MA, Liebeskind DS (2010) Fluid-attenuated inversion recovery vascular hyperintensities: an important imaging marker for cerebrovascular disease. Am J Neuroradiol 32:1771–1775CrossRefPubMed

Iancu-Gontard D, Oppenheim C, Touze E, Meary E, Zuber M, Mas J-L et al (2003) Evaluation of hyperintense vessels on FLAIR MRI for the diagnosis of multiple intracerebral arterial stenoses. Stroke 34:1886–1891CrossRefPubMed

10.

Ahn SJ, Suh SH, Lee K-Y, Kim JH, Seo K-D, Lee S (2015) Hyperintense vessels on T2-PROPELLER-FLAIR in patients with acute MCA stroke: prediction of arterial stenosis and perfusion abnormality. Am J Neuroradiol 36:2042–2047CrossRefPubMed

11.

Yun TJ, Sohn C-H, Han MH, Yoon B-W, Kang H-S, Kim JE et al (2012) Effect of carotid artery stenting on cerebral blood flow: evaluation of hemodynamic changes using arterial spin labeling. Neuroradiology 55:271–281CrossRefPubMed

12.

Uchihashi Y, Hosoda K, Zimine I, Fujita A, Fujii M, Sugimura K et al (2011) Clinical application of arterial spin-labeling MR imaging in patients with carotid stenosis: quantitative comparative study with single-photon emission CT. Am J Neuroradiol 32:1545–1551CrossRefPubMed

13.

Takahashi H, Ishii K, Hosokawa C, Hyodo T, Kashiwagi N, Matsuki M et al (2013) Clinical application of 3D arterial spin-labeled brain perfusion imaging for Alzheimer disease: comparison with brain perfusion SPECT. Am J Neuroradiol 35:906–911CrossRefPubMed

14.

Wong AM, Yan F-X, Liu H-L (2013) Comparison of three-dimensional pseudo-continuous arterial spin labeling perfusion imaging with gradient-echo and spin-echo dynamic susceptibility contrast MRI. J Magn Reson Imaging 39:427–433CrossRefPubMed

15.

Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N et al (2002) Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage 15:273–289CrossRefPubMed

16.

Chang T-Y, Kuan W-C, Huang K-L, Chang C-H, Chang Y-J, Wong H-F et al (2013) Heterogeneous cerebral vasoreactivity dynamics in patients with carotid stenosis. PLoS One 8:e76072CrossRefPubMedPubMedCentral

17.

Cosnard G, Duprez T, Grandin C, Smith AM, Munier T, Peeters A (1999) Fast FLAIR sequence for detecting major vascular abnormalities during the hyperacute phase of stroke: a comparison with MR angiography. Neuroradiology 41:342–346CrossRefPubMed

18.

Kamran S, Bates V, Bakshi R, Wright P, Kinkel W, Miletich R (2000) Significance of hyperintense vessels on FLAIR MRI in acute stroke. Neurology 55:265–269CrossRefPubMed

19.

Toyoda K, Ida M, Fukuda K (2001) Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia. AJNR 22:1021–1029PubMed

20.

Hacein-Bey L, Mukundan G, Shahi K, Chan H, Tajlil AT (2014) Hyperintense ipsilateral cortical sulci on FLAIR imaging in carotid stenosis: ivy sign equivalent from enlarged leptomeningeal collaterals. Clin Imaging 38:314–317CrossRefPubMed

21.

Meyers PM, Higashida RT, Phatouros CC, Malek AM, Lempert TE, Dowd CF et al (2000) Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery 47:335–345CrossRefPubMed

22.

Kufner A, Galinovic I, Ambrosi V, Nolte CH, Endres M, Fiebach JB et al (2015) Hyperintense vessels on FLAIR: hemodynamic correlates and response to thrombolysis. Am J Neuroradiol 36:1426–1430CrossRefPubMed

23.

Lee KY, Latour LL, Luby M, Hsia AW, Merino JG, Warach S (2009) Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke? Neurology 72:1134–1139CrossRefPubMedPubMedCentral

24.

Kim SE, Lee BI, Shin KJ, Park J, Park KM, Kim HC et al (2016) Clinical significance of fluid-attenuated inversion recovery vascular hyperintensities in borderzone infarcts. Stroke 47:1548–1554CrossRefPubMed

25.

MacIntosh BJ, Sideso E, Donahue MJ, Chappell MA, Gunther M, Handa A et al (2011) Intracranial hemodynamics is altered by carotid artery disease and after endarterectomy: a dynamic magnetic resonance angiography study. Stroke 42:979–984CrossRefPubMed

26.

Campbell AM, Beaulieu C (2006) Pulsed arterial spin labeling parameter optimization for an elderly population. J Magn Reson Imaging 23:398–403CrossRefPubMed

27.

Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF et al (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003CrossRefPubMedPubMedCentral

28.

Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS et al (2014) Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 383:333–341CrossRefPubMed

Title: Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting
Authors: Chih-Cheng Wan
David Yen-Ting Chen
Ying-Chi Tseng
Feng-Xian Yan
Kun-Yu Lee
Chen-Hua Chiang
Chi-Jen Chen
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 8/2017
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-017-1863-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2017

Differential diagnosis of parkinsonism by a combined use of diffusion kurtosis imaging and quantitative susceptibility mapping

Extended diffusion weighted magnetic resonance imaging with two-compartment and anomalous diffusion models for differentiation of low-grade and high-grade brain tumors in pediatric patients

European Society of Neuroradiology (ESNR)

Differences in dynamic and static functional connectivity between young and elderly healthy adults

Sensitivity of susceptibility-weighted imaging in detecting developmental venous anomalies and associated cavernomas and microhemorrhages in children

Cortical venous disease severity in MELAS syndrome correlates with brain lesion development