, Volume 56, Issue 9, pp 697–707 | Cite as

FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion

  • Alex FörsterEmail author
  • Holger Wenz
  • Hans Ulrich Kerl
  • Mansour Al-Zghloul
  • Sonia Habich
  • Christoph Groden
Diagnostic Neuroradiology



The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth.


In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms.


In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI–perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI–(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI–PWI mismatch ratio.


In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance.


Collaterals Posterior circulation Stroke FLAIR vascular hyperintensity 


Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Medizinische Ethikkommission II der Medizinischen Fakultät Mannheim and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Patient consent was waived for this retrospective study; however, MRI studies were performed with informed consent of the patient or the patient’s relatives.

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alex Förster
    • 1
    Email author
  • Holger Wenz
    • 1
  • Hans Ulrich Kerl
    • 1
  • Mansour Al-Zghloul
    • 1
  • Sonia Habich
    • 1
  • Christoph Groden
    • 1
  1. 1.Department of Neuroradiology, Universitätsmedizin MannheimUniversity of HeidelbergMannheimGermany

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