Significance of hyperintense arteries on Gd-enhanced 3D T1W black-blood imaging in acute stroke

Abstract

OBJECTIVES: To elucidate the pathogenesis of hyperintense arteries on Gd-enhanced 3D T1W BB FSE and their clinical significance in acute middle cerebral artery (MCA) stroke.

METHODS: We retrospectively reviewed 20 patients with MCA infarction. We measured the contrast-to-noise ratio between hyperintense artery and adjacent grey matter on T2-FLAIR and Gd-enhanced 3D T1W BB FSE and compared them by using Student's t test. The agreement of positive hyperintense artery between T2 FLAIR and Gd-enhanced 3D T1WI BB FSE was estimated with intraclass correlation coefficient. Our cohort was dichotomised into two groups depending on hyperintense artery scores, and clinical data were compared between two groups by using Student's t test and chi-square test.

RESULTS: The contrast between hyperintense artery and grey matter on Gd-enhanced 3D T1W BB FSE was significantly higher than that on T2-FLAIR (2.27 ± 1.65 versus 0.94 ± 0.86, p = 0.01). Overall, agreement of hyperintense arteries on T2-FLAIR and Gd-enhanced 3D T1W BB FSE was excellent (ρ = 0.76, p < 0.01). Patients with higher hyperintense artery scores had higher perfusion deficits that those with lower hyperintense artery scores (196.7 ± 41.4 vs 100.1 ± 130.1, p = 0.03).

CONCLUSION: Hyperintense arteries on Gd-enhanced 3D T1W BB FSE in acute MCA stroke may be associated with slow collateral flows. Their territories corresponded to those of FLAIR, but had a better contrast. The patients with hyperintense arteries in a wider territory showed larger perfusion deficit than those with hyperintense arteries in a narrower territory.

KEY POINTS: • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are slow collateral flows. • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are well matched with FLAIR hyperintense vessels. • Hyperintense arteries are associated with perfusion deficit in stroke patients.