Abstract 3352: Sulcal Effacement On Flair MRI In Hyperacute Stroke: Association With Collateral Flow And Clinical Outcomes

Abstract

Background: 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 (FLAIR) MRI and hypothesized that PSE may be related to collateral flow status together with hyperintense vessels (HVs) on FLAIR in hyperacute stroke. In addition, we investigated whether an association between PSE and clinical outcome could be found in these patients. Methods: Consecutive patients with acute middle cerebral artery (MCA) infarcts within six hours of symptom onset were included. All patients had internal carotid artery (ICA) or MCA occlusion and underwent MRI including FLAIR. The presence of PSE and HVs on FLAIR ( figure ) and the collateral status and occurrence of early recanalization (ER) on conventional angiography were evaluated. Results: Of 139 patients, 79 (56.8%) had PSE. Multivariate testing revealed PSE was independently associated with collateral status. The association between HVs and collaterals was different depending on PSE. Compared to PSE (+) and ER (-) patients, PSE (-) and ER (-) patients (OR 4.11, 95% CI, 1.12-15.17) and PSE (-) and ER (+) patients (OR 34.62, 95% CI, 5.75-208.60), but not PSE (+) and ER (+) patients were more likely to experience favorable clinical outcomes (mRS≤2 at three months). Conclusion: PSE is independently associated with collateral status in patients with acute MCA stroke. Moreover, PSE in conjunction with recanalization status can predict clinical outcomes in these patients. Figure . Typical examples of perisylvian sulcal effacement (PSE; dotted circle) and distal hyperintense vessels (HVs; arrow head) on FLAIR MRI. (a) PSE (+) with subtle distal HVs (b) PSE (+) with prominent distal HVs (c) PSE (-) without distal HVs (d) PSE (+) with prominent distal HVs