Hyperintense vessels on acute stroke fluid-attenuated inversion recovery imaging: Associations with clinical and other MRI findings

Bastian Cheng, Martin Ebinger, Anna Kufner, Martin Köhrmann, Ona Wu, Dong Wha Kang, David Liebeskind, Thomas Tourdias, Oliver C. Singer, Soren Christensen, Steve Warach, Marie Luby, Jochen B. Fiebach, Jens Fiehler, Christian Gerloff, Götz Thomalla

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Background and Purpose-Hyperintense vessels (HVs) have been observed in fluid-attenuated inversion recovery imaging of patients with acute ischemic stroke and been linked to slow flow in collateral arterial circulation. Given the potential importance of HV, we used a large, multicenter data set of patients with stroke to clarify which clinical and imaging factors play a role in HV. Methods-We analyzed data of 516 patients from the previously published PRE-FLAIR study (PREdictive value of FLAIR and DWI for the identification of acute ischemic stroke patients ≤3 and ≤4.5 hours of symptom onset-a multicenter study) study. Patients were studied by MRI within 12 hours of symptom onset. HV were defined as hyperintensities in fluid-attenuated inversion recovery corresponding to the typical course of a blood vessel that was not considered the proximal, occluded main artery ipsilateral to the diffusion restriction. Presence of HV was rated by 2 observers and related to clinical and imaging findings. Results-Presence of HV was identified in 240 of all 516 patients (47%). Patients with HV showed larger initial ischemic lesion volumes (median, 12.3 versus 4.9mL; P<0.001) and a more severe clinical impairment (median National Institutes of Health Stroke Scale 10.5 versus 6; P<0.001). In 198 patients with MR angiography, HVs were found in 80% of patients with vessel occlusion and in 17% without vessel occlusion. In a multivariable logistic regression model, vessel occlusion was associated with HV (OR, 21.7%; 95% CI, 9.6-49.9; P<0.001). HV detected vessel occlusion with a specificity of 0.86 (95% CI, 0.80-0.90) and sensitivity of 0.76 (95% CI, 0.69-0.83). Conclusions-HVs are a common finding associated with proximal arterial occlusions and more severe strokes. HVs predict arterial occlusion with high diagnostic accuracy.

Original languageEnglish (US)
Pages (from-to)2957-2961
Number of pages5
Issue number11
StatePublished - Nov 2012


  • acute stroke
  • diffusion-weighted
  • fluid-inversion recovery
  • magnetic resonance imaging
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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