Fluid-attenuated inversion recovery vascular hyperintensities are not visible using 3D CUBE FLAIR sequence.

OBJECTIVE: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH), initially described on 2D FLAIR images, are a useful imaging marker in patients with acute ischaemic stroke. We aimed to compare the sensitivity of the 3D CUBE FLAIR sequence with 2D FLAIR for the detection of FVH. METHODS: Forty-seven consecutive patients admitted for a suspected stroke were explored by 2D and 3D CUBE FLAIR MR sequences at 1.5 and 3 T. Three blinded readers assessed FVH defined as hyperintensities within cerebral arteries. Location of FVH, acute brain infarct and arterial stenosis were also assessed. 2D images were compared with 3D images for the detection of FVH. Agreement between readers was assessed. RESULTS: Of the 47 patients, 21 FVHs were observed on 2D FLAIR images of 15 patients (11 with acute brain infarct and 11 with an arterial stenosis). No FVH was visualised on 3D CUBE FLAIR images for either proximal or distal locations. Agreement between readers was excellent. CONCLUSION: FVHs are not visible using 3D CUBE FLAIR images. This study suggests that, in suspected acute ischaemic stroke, the assessment of FVH should only be performed on conventional 2D FLAIR images. KEY POINTS: • Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are of neuroradiological importance. • FVHs are useful imaging markers in patients with an acute ischaemic stroke. • FVHs are not visible using 3D CUBE FLAIR images. • Assessment of FVH should be performed on conventional 2D FLAIR images.