Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke

J Neuroradiol. 2022 May;49(3):258-266. doi: 10.1016/j.neurad.2021.01.009. Epub 2021 Jan 28.


Fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) is a common presentation on brain magnetic resonance images of patients with acute ischemic stroke. This sign is known as a sluggish collateral flow. Although FVH represents the large ischemic penumbra and collateral circulation, the clinical significance of FVH has not been established. Varying protocols for FLAIR, treatment differences, and heterogeneity of endpoints across studies have complicated the interpretation of FVH in patients with acute stroke. In this review article, we describe the mechanism of FVH, as well as its association with functional outcome, perfusion-weighted images, and large artery stenosis. In addition, we review the technological variables that affect FVH and discuss the future perspectives.

Keywords: Collateral; FLAIR; FLAIR vascular hyperintensity (FVH); MRI; Perfusion; Stroke.

Publication types

  • Review

MeSH terms

  • Brain Ischemia* / complications
  • Brain Ischemia* / diagnostic imaging
  • Collateral Circulation
  • Humans
  • Ischemic Stroke*
  • Magnetic Resonance Imaging
  • Retrospective Studies
  • Stroke* / complications