The Diagnostic And Prognostic Research Of MRI Fluid-attenuated Inversion Recovery Hyperintense Vessel Sign In Acute Phase Of Patients With Ischemic Stroke

OBJECTIVEThe hyperintense vessel sign(HVS) was frequently found in the sulus and fissures ofpatients’ cerebrum with ischemic stroke on MR images(MRI) fluid-attenuated inversionrecovery(FLAIR), whose formation mechanism and clinical significance was still unclear.In this study, we aimed to investigate the imaging characteristic and early diagnosis andclinical prognostic value of the FLAIR HVS to patients with ischemic stroke.METHODSFrom Aug2012to Aug2014,155patients with acute ischemic stroke in SuzhouKowloon Hospital were performed with MRI (including FLAIR, DWI and MRA) and CTAto observe the stenosis or occlusion status of different arteries and to compare the infarctvolume with DWI, the NIHSS score (national institute of health stroke scale)and MRSscore(modified Rankin Scale) of30days after dischargeRESULTS1. HVS was observed in86patients of the155patients (male84, female71). HVSwas found in the anterior circulation in55patients, including HVS positive in middlecerebral artery in44patients, HVS positive in internal carotid in8patients, HVS positivein anterior cerebral artery in3patients; HVS was found in posterior circulation in31patients, including HVS positive in posterior cerebral artery in21patients, HVS positive inbasilar artery in6patients and HVS positive vertebral artery in4patients.2. The percentage of positive HVS was1/16(6%) in mild stenosis group,7/18(38%) insevere stenosis group and36/57(63%) in occlusion group in the middle cerebral artery.Compare the mild stenosis group with severe stenosis group, p＝0.025, the difference wasstatistically significant; compare the severe stenosis group with occlusion group, p＜0.01，the difference was statistically significant. 3. HVS was found36patients of57patients（mean age61.93±10.73years）withmiddle cerebral artery occlusion, the mean NIHSS score was （10.40±4.61）,28patientswere distal HVS positive,8patients were proximal HVS positive,21patients were HVSnegative.4. The infarct volume and NIHSS score of distal HVS positive group was better thanthe distal HVS negative group (proximal HVS positive group plus HVS negative group,p<0.03). The MRS score30days after discharge of distal HVS positive group was betterthan the distal HVS negative group. Distal HVS positive was prognostic worthwhile for theshort-term clinical outcomes.5. HVS was found19patients of31patients with posterior cerebral artery occlusion,There was no significant difference between the HVS positive group and HVS negativegroup in the risk factors distribution, infarct volume, NIHSS score and mRS score30daysafter discharge of patients with posterior cerebral artery occlusion.CONCLUSIONS1. T2-FLAIR HVS is an early sign of acute cerebral infarction of patients withischemic cerebral stroke, which indicates the severe stenosis or occlusion.2. The disappearance of flowing void effect caused by slow blood flow might be theunderlying structure of MRI T2-FLAIR HVS of patients with ischemic cerebral stroke.3. Distal HVS was partial correlated to infarct volume in patients with middle cerebralartery occlusion and prognostic positive for the outcome; HVS positive was not stronglyrelated to the outcome of patients with posterior artery occlusion.4. In combination with T2-FLAIR HVS and MRA can rapidly and accuratelypositioning cerebral infarction and the scope of the region and the degree of vascularlesions, help early diagnosis, clinical guidance to choose the appropriate treatment.