Early Stage of Hyperintense Acute Reperfusion Marker on Contrast-Enhanced FLAIR Images in Patients With Acute Stroke

AJR Am J Roentgenol. 2016 Jun;206(6):1272-5. doi: 10.2214/AJR.15.14857. Epub 2016 Mar 24.


Objective: Hyperintense acute reperfusion marker (HARM) is defined as delayed CSF enhancement on FLAIR images in patients with acute stroke and was observed in follow-up FLAIR images after initial MRI with contrast material administration. We hypothesized that different imaging findings of HARM could be present depending on the timing of FLAIR imaging after contrast material administration.

Subjects and methods: Of 218 consecutive patients with acute stroke or transient ischemic attack over 3 months, 12 with linear contrast enhancement on the cortical surface in initial FLAIR images underwent serial FLAIR imaging. Initial FLAIR images were obtained 5 minutes after contrast material administration, and follow-up unenhanced FLAIR images were obtained 2.5-29 hours (mean, 13.2 hours) after initial FLAIR imaging. The enhancement patterns between initial and follow-up FLAIR images were compared.

Results: In all 12 patients, initial contrast-enhanced FLAIR images showed focal or multifocal linear contrast enhancement along the cortical surface near acute infarctions. On follow-up unenhanced FLAIR images, initial cortical enhancement spread diffusely and filled the subarachnoid space.

Conclusion: HARM in acute stroke can be detected earlier than previously reported on initial contrast-enhanced FLAIR images. Different imaging findings of HARM depend on the timing of FLAIR imaging after contrast material administration.

Keywords: acute ischemic stroke; blood-brain barrier; contrast-enhanced FLAIR image; hyperintense acute reperfusion marker.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnostic imaging*
  • Contrast Media / administration & dosage
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Organometallic Compounds / administration & dosage
  • Prospective Studies
  • Stroke / diagnostic imaging*


  • Contrast Media
  • Organometallic Compounds
  • gadobutrol