RT Journal Article SR Electronic T1 Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy? JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 77 OP 83 DO 10.3174/ajnr.A5431 VO 39 IS 1 A1 E. Mahdjoub A1 G. Turc A1 L. Legrand A1 J. Benzakoun A1 M. Edjlali A1 P. Seners A1 S. Charron A1 W. Ben Hassen A1 O. Naggara A1 J.-F. Meder A1 J.-L. Mas A1 J.-C. Baron A1 C. Oppenheim YR 2018 UL http://www.ajnr.org/content/39/1/77.abstract AB BACKGROUND AND PURPOSE: In acute ischemic stroke, whether FLAIR vascular hyperintensities represent good or poor collaterals remains controversial. We hypothesized that extensive FLAIR vascular hyperintensities correspond to good collaterals, as indirectly assessed by the hypoperfusion intensity ratio.MATERIALS AND METHODS: We included 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The median hypoperfusion intensity ratio was used to dichotomize good (low hypoperfusion intensity ratio) versus poor (high hypoperfusion intensity ratio) collaterals. We then studied the association between FLAIR vascular hyperintensity extent and hypoperfusion intensity ratio.RESULTS: Hypoperfusion was present in all patients, with a median hypoperfusion intensity ratio of 0.35 (interquartile range, 0.19–0.48). The median FLAIR vascular hyperintensity score was 4 (interquartile range, 3–5). The FLAIR vascular hyperintensities were more extensive in patients with good collaterals (hypoperfusion intensity ratio ≤0.35) than with poor collaterals (hypoperfusion intensity ratio >0.35; P for Trend = .016). The FLAIR vascular hyperintensity score was independently associated with good collaterals (P for Trend = .002).CONCLUSIONS: In patients eligible for reperfusion therapy, FLAIR vascular hyperintensity extent was associated with good collaterals, as assessed by the pretreatment hypoperfusion intensity ratio. The ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.FVHFLAIR vascular hyperintensityHIRhypoperfusion intensity ratioIQRinterquartile rangeTmaxtime-to-maximum