Background: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) document slowed vascular flow at the level and after the occlusion site patients with acute ischemic stroke (AIS). We aimed to assess the accuracy of FVH for the confirmation and location of a large vessel occlusion (LVO). Methods: Three radiologists reviewed the FLAIR sequence of the admission MRI exam of patients with suspected AIS at a single academic center. Readers were provided with the main clinical deficit with National Institute of Health Stroke Severity score and were asked to identify and locate an LVO when appropriate. Kappa coefficients were calculated for agreement along with diagnosis performances of FVH to recognize and locate an LVO with digital subtracted angiography (DSA) as gold standard. Results: Among 125 patients screened with MRI for a suspected AIS, 96 (81%) were diagnosed with AIS and 47 (38%) patients had an anterior LVO of whom 25 (20%) had a DSA for mechanical thrombectomy. Kappa coefficients for intra- and inter-readers were good to excellent. Overall, the sensitivity and the specificity of the FVH to predict an anterior LVO was 0.98 (95% confidence interval [CI]: 0.94–1) and 0.86 (95% CI: 0.79–0.96), respectively, while PPV and NPV were 0.87 (95% CI: 0.85–0.95) and 0.98 (0.97–1), respectively. FVH also showed good to excellent accuracy for identifying M1 and M2 versus internal carotid artery occlusion site. Conclusion: We found that FVH demonstrated excellent diagnostic performances for the identification of LVO and its level with good to excellent reproducibility. This MRI radio marker of occlusion provides additional arguments and may speed-up the detection of potential candidates for MT.

中文翻译：

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疑似大动脉血管闭塞患者的加速 MR 评估：FLAIR 血管高信号的诊断性能

背景：液体衰减反转恢复 (FLAIR) 血管高信号 (FVH) 记录了急性缺血性中风 (AIS) 患者在闭塞部位水平和之后的血管流动减慢。我们旨在评估 FVH 在确认和定位大血管闭塞 (LVO) 方面的准确性。方法：三位放射科医师在一个学术中心回顾了疑似 AIS 患者入院 MRI 检查的 FLAIR 序列。向读者提供了美国国立卫生研究院卒中严重程度评分的主要临床缺陷，并要求他们在适当的时候识别和定位 LVO。计算 Kappa 系数与 FVH 的诊断性能一致，以识别和定位 LVO，数字减影血管造影 (DSA) 作为金标准。结果：在通过 MRI 筛查疑似 AIS 的 125 名患者中，96 名 (81%) 被诊断为 AIS，47 名 (38%) 患者有前路 LVO，其中 25 (20%) 名患者进行了 DSA 机械取栓。阅读器内和阅读器间的 Kappa 系数从好到极好。总体而言，FVH 预测前路 LVO 的敏感性和特异性分别为 0.98（95% 置信区间 [CI]：0.94-1）和 0.86（95% CI：0.79-0.96），而 PPV 和 NPV 为 0.87 (95% CI: 0.85–0.95) 和 0.98 (0.97–1)，分别。FVH 在识别 M1 和 M2 与颈内动脉闭塞部位方面也显示出良好至极好的准确性。结论：我们发现 FVH 在识别 LVO 及其水平方面表现出出色的诊断性能，并且具有良好到极好的重现性。