Hyperintense Vessel Sign on High-Resolution Vessel Wall MRI and Perfusion Decompensation in Intracranial Atherosclerotic Disease: Burden Versus Proximal Extent.

Rationale

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Objectives

To investigate the relationship between hyperintense vessel sign (HVS) on high-resolution magnetic resonance vessel wall imaging (HR-VWI) and cerebral perfusion decompensation in patients with intracranial atherosclerotic stenosis or occlusion.

Materials And Methods

This retrospective cohort included 128 patients with unilateral intracranial atherosclerotic stenosis or occlusion undergoing HR-VWI and computed tomography perfusion. HVS was scored by vessel count and classified by extent (type 0, none; type 1, M3-M4; type 2, M1-M2); local collaterals were assessed on time-of-flight magnetic resonance angiography. Prespecified Firth-penalized regression, bootstrap-validated threshold modeling, hierarchical likelihood-ratio tests, and collateral-phenotype analysis compared grade 2 versus grade 1.

Results

The study cohort comprised 128 patients (92 males, 36 females), with a mean age of 55.08 ± 10.58 years. 85 patients were grade 1, 43 grade 2. HVS score was independently associated with decompensation (odds ratio [OR], 1.09, P = 0.04), with an exploratory cutoff at 8 (bootstrap 95% confidence interval [CI], 6-8; adjusted OR, 6.93, P < 0.01). Grade-2 proportions differed across type 0/1/2 (25.00%/22.67%/63.64%); type 2 exceeded type 1 (adjusted OR 8.06, P < 0.01). Classification, not the score, added incremental value (likelihood ratio P < 0.01 vs reverse P = 0.15). Type 1 with collateral present marked compensation (5.88%; negative predictive value 0.94); type 2 with collateral absent marked decompensation (66.67%; adjusted OR = 33.90, P < 0.01). Score ≥8 gave 0.65 sensitivity and 0.80 specificity; combined-model area under the curve was 0.83 (95% CI, 0.75-0.90; optimism-corrected 0.79).

Conclusion

HVS score provides an exploratory screening cutoff, whereas proximal HVS extension into M1-M2 is strongly associated with decompensation; distal-limited HVS with local collateral formation marks compensation. Prospective multicenter validation is required before clinical implementation.