Sulcal Effacement on Fluid Attenuation Inversion Recovery Magnetic Resonance Imaging in Hyperacute Stroke: Association With Collateral Flow and Clinical Outcomes

• Published in: Stroke (1970) Vol. 43; no. 2; pp. 386 - 392
• Main Authors: SUK JAE KIM, YEON SOO HA, RYOO, Sookyung, HYUN JIN NOH, HA, Sam-Yeol, OH YOUNG BANG, KIM, Gyeong-Moon, CHUNG, Chin-Sang, KWANG HO LEE
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2012
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carotid Stenosis - complications; Carotid Stenosis - pathology; Cerebral Angiography; Cerebrovascular Circulation - physiology; Collateral Circulation - physiology; Diffusion Magnetic Resonance Imaging; Female; Humans; Image Processing, Computer-Assisted; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - pathology; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Nervous system; Neurology; Predictive Value of Tests; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Recovery of Function; Registries; Stroke - pathology; Stroke - physiopathology; Stroke - therapy; Thrombolytic Therapy; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Young Adult; acute; Stroke; Nervous system diseases; Prognosis; collaterals; Inversion recovery; Cardiovascular disease; Nuclear magnetic resonance imaging; Cerebral disorder; Vascular disease; Central nervous system disease; sulcal effacement; Attenuation; Cerebrovascular disease; fluid attenuation inversion recovery; Hyperacute
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.111.638106

The clinical significance of sulcal effacement has been widely investigated in CT studies, but the results are controversial. In this study, we evaluated the presence of perisylvian sulcal effacement (PSE) on fluid attenuation inversion recovery MRI and hypothesized that PSE may be related to collateral flow status together with hyperintense vessels on fluid attenuation inversion recovery in hyperacute stroke. In addition, we investigated whether an association between PSE and clinical outcome could be found in these patients. Consecutive patients with acute middle cerebral artery infarcts within 6 hours of symptom onset were included. All patients had internal carotid artery or middle cerebral artery occlusion and underwent MRI including FLAIR. The presence of PSE and hyperintense vessels on fluid attenuation inversion recovery and the collateral status and occurrence of early recanalization (ER) on conventional angiography were evaluated. Of 139 patients, 79 (56.8%) had PSE. Multivariate testing revealed PSE was independently associated with collateral status. The association between hyperintense vessels and collaterals was different depending on PSE. Compared to PSE-positive and ER-negative patients, PSE-negative and ER-negative patients (odds ratio, 4.11; 95% confidence interval, 1.12-15.17) and PSE-negative and ER-positive patients (odds ratio, 34.62; 95% confidence interval, 5.75-208.60), but not PSE-positive and ER-positive patients, were more likely to experience favorable clinical outcomes (modified Rankin Scale score ≤ 2 at 3 months). PSE is independently associated with collateral status in patients with acute middle cerebral artery stroke. Moreover, PSE in conjunction with recanalization status can predict clinical outcomes in these patients.