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PT  - JOURNAL ARTICLE
AU  - Gawlitza, M.
AU  - Quäschling, U.
AU  - Hobohm, C.
AU  - Otto, J.
AU  - Voigt, P.
AU  - Hoffmann, K.-T.
AU  - Lobsien, D.
TI  - Hyperintense Basilar Artery on FLAIR MR Imaging: Diagnostic Accuracy and Clinical Impact in Patients with Acute Brain Stem Stroke
AID  - 10.3174/ajnr.A3961
DP  - 2014 May 08
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2014/05/08/ajnr.A3961.short
4100  - http://www.ajnr.org/content/early/2014/05/08/ajnr.A3961.full
AB  - BACKGROUND AND PURPOSE: FLAIR-hyperintense vessels are known to be a sign of sluggish collateral blood flow in hemispheric vessel occlusion. Additionally, they seem to have a prognostic implication. The aim of the current study was to evaluate the hyperintense configuration of the basilar artery (FLAIR-hyperintense basilar artery) as a marker of basilar artery occlusion and as a predictor of patient outcome. MATERIALS AND METHODS: We retrospectively identified 20 patients with basilar artery occlusion who initially underwent MR imaging with subsequent DSA. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperintense basilar artery and DWI posterior circulation–ASPECTS, patient outcome, and patient survival was evaluated. To grade the extent of the FLAIR-hyperintense basilar artery sign, we generated a score by counting the number of sections from the basilar tip to the foramen magnum in which a hyperintense signal in the vessel lumen was present multiplied by the section thickness. RESULTS: The FLAIR-hyperintense basilar artery sign showed moderate sensitivity (65%–95%) but very good specificity (95%–100%) and accuracy (85%–93%) for the detection of basilar artery occlusion. Substantial or excellent inter-reader agreement was observed (Cohen ĸ, 0.64–0.85). The FLAIR-hyperintense basilar artery inversely correlated with the posterior circulation–ASPECTS (r = −0.67, P = .01). Higher FLAIR-hyperintense basilar artery scores were associated with patient death (28.3 ± 13.7 versus 13.4 ± 11.1, P &amp;lt; .05). CONCLUSIONS: The FLAIR-hyperintense basilar artery sign proved to be a valuable marker of vessel occlusion and may substantially support the diagnosis of basilar artery occlusion. The established FLAIR-hyperintense basilar artery score may be helpful for the prediction of individual patient survival. Abbreviations BAObasilar artery occlusionFHBAFLAIR-hyperintense basilar arteryFHVFLAIR-hyperintense vesselpc-ASPECTSposterior circulation–ASPECTS