The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients

Purpose: The hyperintense acute reperfusion marker (HARM) is characterized by the delayed enhancement of the subarachnoid or subpial space observed on postcontrast fluid-attenuated inversion recovery (FLAIR) images, and is considered a cerebral reperfusion marker for various brain disorders, includi...

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Autores principales:	Ji Young Lee, Kyung Mi Lee, Hyug-Gi Kim, Ho-Geol Woo, Jin San Lee, Eui Jong Kim
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	subacute infarction postcontrast FLAIR HARM sign ischemia Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/155e23f3c0f2493388511e21c6e8f3b2
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spelling	oai:doaj.org-article:155e23f3c0f2493388511e21c6e8f3b22021-11-25T17:22:10ZThe Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients10.3390/diagnostics111121612075-4418https://doaj.org/article/155e23f3c0f2493388511e21c6e8f3b22021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/2161https://doaj.org/toc/2075-4418Purpose: The hyperintense acute reperfusion marker (HARM) is characterized by the delayed enhancement of the subarachnoid or subpial space observed on postcontrast fluid-attenuated inversion recovery (FLAIR) images, and is considered a cerebral reperfusion marker for various brain disorders, including infarction. In this study, we evaluated the cerebral distribution patterns of HARM for discriminating between an enhancing subacute infarction and an enhancing mass located in the cortex and subcortical white matter. Materials and methods: We analyzed consecutive patients who experienced a subacute ischemic stroke, were hospitalized, and underwent conventional brain magnetic resonance imaging including postcontrast FLAIR within 14 days from symptom onset, as well as those who had lesions corresponding to a clinical sign detected by diffusion-weighted imaging and postcontrast T1-weighted imaging between May 2019 and May 2021. A total of 199 patients were included in the study. Of them, 94 were finally included in the subacute infarction group. During the same period, 76 enhancing masses located in the cortex or subcortical white matter, which were subcategorized as metastasis, malignant glioma, and lymphoma, were analyzed. We analyzed the overall incidence of HARM in subacute ischemic stroke cases, and compared the enhancement patterns between cortical infarctions and cortical masses. Results: Among 94 patients with subacute stroke, 78 patients (83%) presented HARM, and among 76 patients with subcortical masses, 48 patients (63%) presented peripheral rim enhancement. Of 170 subcortical enhancing lesions, 88 (51.8%) showed HARM, and 78 (88.6%) were determined to be subacute infarction. Among 94 patients with subacute stroke, 48 patients (51%) had diffusion restrictions, and HARM was found in 39 patients (81.2%). Of the 46 patients (49%) without diffusion restriction, 39 patients (84.8%) showed HARM. Conclusions: The presence of HARM was significantly associated with subacute infarctions. For the masses, a peripheral rim enhancement pattern was observed around the mass rather than the cerebral sulci on postcontrast FLAIR.Ji Young LeeKyung Mi LeeHyug-Gi KimHo-Geol WooJin San LeeEui Jong KimMDPI AGarticlesubacute infarctionpostcontrast FLAIRHARM signischemiaMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 2161, p 2161 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	subacute infarction postcontrast FLAIR HARM sign ischemia Medicine (General) R5-920
spellingShingle	subacute infarction postcontrast FLAIR HARM sign ischemia Medicine (General) R5-920 Ji Young Lee Kyung Mi Lee Hyug-Gi Kim Ho-Geol Woo Jin San Lee Eui Jong Kim The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
description	Purpose: The hyperintense acute reperfusion marker (HARM) is characterized by the delayed enhancement of the subarachnoid or subpial space observed on postcontrast fluid-attenuated inversion recovery (FLAIR) images, and is considered a cerebral reperfusion marker for various brain disorders, including infarction. In this study, we evaluated the cerebral distribution patterns of HARM for discriminating between an enhancing subacute infarction and an enhancing mass located in the cortex and subcortical white matter. Materials and methods: We analyzed consecutive patients who experienced a subacute ischemic stroke, were hospitalized, and underwent conventional brain magnetic resonance imaging including postcontrast FLAIR within 14 days from symptom onset, as well as those who had lesions corresponding to a clinical sign detected by diffusion-weighted imaging and postcontrast T1-weighted imaging between May 2019 and May 2021. A total of 199 patients were included in the study. Of them, 94 were finally included in the subacute infarction group. During the same period, 76 enhancing masses located in the cortex or subcortical white matter, which were subcategorized as metastasis, malignant glioma, and lymphoma, were analyzed. We analyzed the overall incidence of HARM in subacute ischemic stroke cases, and compared the enhancement patterns between cortical infarctions and cortical masses. Results: Among 94 patients with subacute stroke, 78 patients (83%) presented HARM, and among 76 patients with subcortical masses, 48 patients (63%) presented peripheral rim enhancement. Of 170 subcortical enhancing lesions, 88 (51.8%) showed HARM, and 78 (88.6%) were determined to be subacute infarction. Among 94 patients with subacute stroke, 48 patients (51%) had diffusion restrictions, and HARM was found in 39 patients (81.2%). Of the 46 patients (49%) without diffusion restriction, 39 patients (84.8%) showed HARM. Conclusions: The presence of HARM was significantly associated with subacute infarctions. For the masses, a peripheral rim enhancement pattern was observed around the mass rather than the cerebral sulci on postcontrast FLAIR.
format	article
author	Ji Young Lee Kyung Mi Lee Hyug-Gi Kim Ho-Geol Woo Jin San Lee Eui Jong Kim
author_facet	Ji Young Lee Kyung Mi Lee Hyug-Gi Kim Ho-Geol Woo Jin San Lee Eui Jong Kim
author_sort	Ji Young Lee
title	The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
title_short	The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
title_full	The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
title_fullStr	The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
title_full_unstemmed	The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients
title_sort	clinical significance of the hyperintense acute reperfusion marker sign in subacute infarction patients
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/155e23f3c0f2493388511e21c6e8f3b2
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The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients

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