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FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion

  • Diagnostic Neuroradiology
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Abstract

Introduction

The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth.

Methods

In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms.

Results

In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI–perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI–(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI–PWI mismatch ratio.

Conclusions

In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Medizinische Ethikkommission II der Medizinischen Fakultät Mannheim and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Patient consent was waived for this retrospective study; however, MRI studies were performed with informed consent of the patient or the patient’s relatives.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Alex Förster, Holger Wenz, Hans Ulrich Kerl, Mansour Al-Zghloul, Sonia Habich & Christoph Groden

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  1. Alex Förster
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  2. Holger Wenz
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Correspondence to Alex Förster.

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Förster, A., Wenz, H., Kerl, H.U. et al. FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion. Neuroradiology 56, 697–707 (2014). https://doi.org/10.1007/s00234-014-1382-7

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  • DOI: https://doi.org/10.1007/s00234-014-1382-7

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