The effect of high signal vascular sign on cerebral blood flow and prognosis in acute cerebral infarction
GAO Li-zhen1, QIAN Yu-quan1, ZHANG Bing2, LIU Jun3
1.Department of Imaging, Taikang Tongji(Wuhan) Hospital, Wuhan 433000, China;
2.Department of Imaging, The Second Affliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China;
3.Department of Imaging, Tianjin People's Hospital, Tianjin 300121, China
Abstract：Objective: To investigate the cerebral parenchymal blood perfusion status in hyperintense vessel sign(HVS) area on fluid attenuated inversion recovery(FLAIR) sequence during acute cerebral infarction and to evaluate the relationship between HVS change and short-term prognosis. Methods: Sixty-seven patients with acute cerebral infarction in middle cerebral artery(MCA) blood supply area without thrombolysis treatment were divided into HVS negative group and HVS positive group according to the presence of HVS. Cerebral blood volume(CBF) value of “HVS-DWI” mismatch area or around the infarct was obtained by 3D-pulsed arterial spin labeling scan. The relationship between HVS and NIHSS score, infarction area, rCBF was analyzed. The relationship between HVS and the change of the disease was observed in 13 HVS positive patients. Results: HVS sign was observed 38(56.7%) of 67 enrolled cases. NIHSS score and the infarction area of HVS positive group were higher than those of HVS negative group(P<0.05). The rCBF value of mismatched areas of “HVS-DWI” was decreased(P=0.012<0.05). Among the re-examination patients, there was no significant change in the range of HVS in 5 patients, with new infarction and progressive disease. Conclusion: In acute cerebral infarction, the appearance of HVS suggests severe neurological dysfunction and large infarction area, and the cerebral parenchymal blood flow in the“HVS-DWI” mismatched areas is hypoperfusion, and the persistence of HVS needs to be vigilant for new infarction.
高利珍1，钱玉泉1，张 冰2，刘 筠3. 急性脑梗塞高信号血管征对脑组织血流灌注及预后的影响[J]. 中国临床医学影像杂志, 2020, 31(5): 305-309.
GAO Li-zhen1, QIAN Yu-quan1, ZHANG Bing2, LIU Jun3. The effect of high signal vascular sign on cerebral blood flow and prognosis in acute cerebral infarction. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(5): 305-309.
[1]Kamran S, Bates V, Bakshi R, et al. Significance of hyperintense vessels on FLAIR MRI in acute stroke [J]. Neurology, 2000, 55(2): 265-269.
[2]Liu W, Xu G, Yue X, et al. Hyperintense vessels on FLAIR: a useful noninvasive method for assessing intracerebral collaterals[J]. Eur J Radiol, 2011, 80(3): 786-791.
[3]陈涓. 一站式CTP-CTA与磁共振ASL灌注成像在缺血性脑卒中的应用价值[D]. 北京：北京协和医学院中国医学科学院 北京协和医学院 清华大学医学部中国医学科学院，2012.
[4]周建国，符大勇，孟云，等. 双时相ASL在DWI阴性TIA诊断中的临床应用价值[J]. 中国临床医学影像杂志，2018，29（2）：137-139.
[5]Gawlitza M, Gragert J, Quaschling U, et al. FLAIR-hyperintense vessel sign, diffusion-perfusion mismatch and infarct growth in acute ischemic stroke without vascular recanalisation therapy[J]. J Neuroradiol, 2014, 41(4): 227-233.
[6]Kufner A, Galinovic I, Ambrosi V, et al. Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis[J]. AJNR, 2015, 36(8): 1426-1430.
[7]Toyoda K, Ida M, Fukuda K. Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia[J]. AJNR, 2001, 22(22): 1021-1029.
[8]Huang X, Liu W, Zhu W, et al. Distal hyperintense vessels on FLAIR: a prognostic indicator of acute ischemic stroke[J]. Eur Neurol, 2012， 68(4): 214-220.
[9]Kono T, Naka H, Nomura E, et al. The association between hyperintense vessel sign and final ischemic lesion differ in its location[J]. J Stroke Cerebrovasc Dis, 2014, 23(6): 1337-1343.
[10]Li CC, Hao XZ, Tian JQ, et al. Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores[J]. Neural Regen Res, 2018, 13(1): 69-76.
[11]卜玮艺，高利珍，刘筠，等. FLAIR高信号血管征在大脑中动脉急性脑梗死中的发生规律[J]. 临床放射学杂志，2019，38（6）：983-987.
[12]刘振生，李澄，王苇，等. 急性脑梗塞腔内再通后液体衰减反转恢复序列高信号血管征变化的意义[J]. 中华放射学杂志，2015，49（7）：535-539.
[13]Gawlitza M, B?觟hme J, Maros M, et al. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia[J]. Plos One, 2017, 12(2): e0172570.
[14]李璇，吴江. 动脉自旋标记技术评估TIA的研究进展[J]. 磁共振成像，2019，10（4）：288-291.
[15]Kohno N, Okada K, Yamagata S, et al. Distinctive patterns of three dimensional arterial spin-Labeled perfusion magnetic resonance imaging in subtypes of acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2016, 25(7): 1807-1812.
2020, Vol. 31 
