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Research ArticleBRAIN
Open Access

Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus

N. Sanossian, J.L. Saver, J.R. Alger, D. Kim, G.R. Duckwiler, R. Jahan, F. Vinuela, B. Ovbiagele and D.S. Liebeskind
American Journal of Neuroradiology March 2009, 30 (3) 564-568; DOI: https://doi.org/10.3174/ajnr.A1388
N. Sanossian
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J.L. Saver
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J.R. Alger
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D. Kim
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G.R. Duckwiler
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R. Jahan
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F. Vinuela
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B. Ovbiagele
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D.S. Liebeskind
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    Fig 1.

    Two cases of retrograde leptomeningeal collateral flow in areas corresponding to FVH. A and B, Case 1: FLAIR demonstrates FVH (arrow) in the Sylvian fissure with an angiogram (B) showing grade 3 collaterals from the ipsilateral ACA. C and D, Case 2: FLAIR (C) demonstrates temporoparietal FVH with ACA-MCA leptomeningeal collaterals on the angiogram (D).

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    Fig 2.

    A case showing grade 4 collaterals on angiography (A) and FVH (C−E) distal to thrombus, demonstrated as an area of blooming artifact (B).

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    Table 1:

    Characteristics and imaging findings in study patients

    FeaturesData
    No. of patients74
    Age (yr)Mean, 63.4
    Sex36 Women (48%)
    Median time from MRI to angiography (hr)2.9 (IQR, 1.1–4.7)
    FVH present53/74 (72%)
    FVH in arterial territory of ischemia53/53 (100%)
    Location of FVH
        Sylvian fissure50/53 (94%)
        Temporal lobe47/53 (89%)
        Frontal lobe28/53 (53%)
        Parietal lobe18/53 (34%)
    Discontinuity or gap in FVH26/53 (49%)
    FVH not noted on angiography21 (28%)
    Angiographic findings in FVH-negative cases
        MCA M1 occlusion1
        MCA M1 stenosis with anterograde flow2
        MCA M2 occlusion2
        Distal (M3 or greater) occlusion8
        ICA occlusion without MCA occlusion2
        Vertebrobasilar occlusion3
        Posterior cerebral occlusion2
        Anterior choroidal occlusion1
    • Note:—MRI indicates MR imaging; FVH, fluid-attenuated inversion recovery vascular hyperintensities; MCA, middle cerebral artery; ICA, internal carotid artery.

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    Table 2:

    The ASITN/SIR collateral-flow grading system to determine angiographic collateral grade on pretreatment angiography

    ASTIN/SIR Collateral GradeDefinition
    0No collaterals visible to the ischemic site
    1Slow collaterals to the periphery of the ischemic site with persistence of some of the defect
    2Rapid collaterals to the periphery of ischemic site with persistence of some of the defect and to only a portion of the ischemic territory
    3Collaterals with slow but complete angiographic blood flow of the ischemic bed by the late venous phase
    4Complete and rapid collateral blood flow to the vascular bed in the entire ischemic territory by retrograde perfusion
    • Note:—ASTIN/SIR indicates American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology.7

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American Journal of Neuroradiology: 30 (3)
American Journal of Neuroradiology
Vol. 30, Issue 3
March 2009
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Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus
N. Sanossian, J.L. Saver, J.R. Alger, D. Kim, G.R. Duckwiler, R. Jahan, F. Vinuela, B. Ovbiagele, D.S. Liebeskind
American Journal of Neuroradiology Mar 2009, 30 (3) 564-568; DOI: 10.3174/ajnr.A1388

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Angiography Reveals That Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Are Due to Slow Flow, Not Thrombus
N. Sanossian, J.L. Saver, J.R. Alger, D. Kim, G.R. Duckwiler, R. Jahan, F. Vinuela, B. Ovbiagele, D.S. Liebeskind
American Journal of Neuroradiology Mar 2009, 30 (3) 564-568; DOI: 10.3174/ajnr.A1388
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  • Ivy Sign in Moyamoya Disease: A Comparative Study of the FLAIR Vascular Hyperintensity Sign Against Contrast-Enhanced MRI
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  • Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy?
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  • Fluid-Attenuated Inversion Recovery Vascular Hyperintensity Topography, Novel Imaging Marker for Revascularization in Middle Cerebral Artery Occlusion
  • Fluid-Attenuated Inversion Recovery Vascular Hyperintensities-Diffusion-Weighted Imaging Mismatch Identifies Acute Stroke Patients Most Likely to Benefit From Recanalization
  • Susceptibility Vessel Sign on MRI Predicts Favorable Clinical Outcome in Patients with Anterior Circulation Acute Stroke Treated with Mechanical Thrombectomy
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  • Correlation of clot imaging with endovascular recanalization in internal carotid artery terminus occlusion
  • Do FLAIR Vascular Hyperintensities beyond the DWI Lesion Represent the Ischemic Penumbra?
  • FLAIR vascular hyperintensity resolution in a TIA patient: Clinical-radiologic correlation
  • Elevated Cerebral Blood Volume Contributes to Increased FLAIR Signal in the Cerebral Sulci of Propofol-Sedated Children
  • Hyperintense Basilar Artery on FLAIR MR Imaging: Diagnostic Accuracy and Clinical Impact in Patients with Acute Brain Stem Stroke
  • Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack
  • Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
  • Hyperintense Vessels on Acute Stroke Fluid-Attenuated Inversion Recovery Imaging: Associations With Clinical and Other MRI Findings
  • Systematic Review of Methods for Assessing Leptomeningeal Collateral Flow
  • Fluid-Attenuated Inversion Recovery Images and Stroke Outcome After Thrombolysis
  • Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease
  • Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease
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