{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:25:05Z","timestamp":1792002305006,"version":"4.4.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Perfusion imaging used to select patients for extended-window stroke therapy is not widely available. We investigated whether fluid-attenuated inversion recovery vascular hyperintensities (FVHs) on routine magnetic resonance imaging could serve as a reliable surrogate for perfusion imaging by predicting the mismatch between hypoperfused tissue volume (perfusion-weighted imaging [PWI]) and infarct core volume (diffusion-weighted imaging [DWI]) in patients with proximal middle cerebral artery occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We included, in a retrospective Bordeaux Hospital study (2021\u20132022), 200 consecutive proximal middle cerebral artery occlusion patients and developed 2 semiquantitative scoring systems\u2014FVH\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      (cortical-Alberta Stroke Program Early Computed Tomography Score) and DWI\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      \u2014based on the 7 c-ASPECTS regions. We assessed the correlation between the FVH\/DWI\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      ratio and the true PWI\/DWI mismatch and analyzed its association with 24-hour and 3-month outcomes. Predictive performance for the PWI\/DWI ratio was tested using the area under the curve\u2013receiver operating characteristic curve. Two thresholds were evaluated\u2014the cohort median PWI\/DWI ratio and PWI\/DWI \u22651.8 with mismatch &gt;15 mL in patients imaged \u22656 hours after onset\u2014and sensitivity, specificity, positive and negative predictive value with 95% CIs were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The FVH\/DWI\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      ratio strongly correlated with the PWI\/DWI mismatch (\n                      <jats:italic toggle=\"yes\">\u03c1<\/jats:italic>\n                      =0.77;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). A ratio \u22651.6 accurately predicted a high PWI\/DWI ratio \u22655 (area under the curve, 0.90; sensitivity, 82.1%; specificity, 85.2%; positive predictive value, 85.7%; negative predictive value, 81.5%). Among patients imaged \u22656 hours after onset, a ratio \u22650.8 identified a moderate PWI\/DWI ratio \u22651.8 with a mismatch &gt;15 mL (area under the curve, 0.92 [95% CI, 0.84\u20131.00]; sensitivity, 97.8%; specificity, 73.3%; positive predictive value, 91.8%; and negative predictive value, 91.7%). The FVH\/DWI\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      ratio was independently associated with early major neurological improvement, 24-hour National Institutes of Health Stroke Scale score decrease \u22658 or at 0 to 1 (odds ratio, 1.31;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004) and inversely associated with hemorrhagic transformation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      The FVH\/DWI\n                      <jats:sub>-c-ASPECTS<\/jats:sub>\n                      ratio is a potential surrogate imaging marker of perfusion-diffusion mismatch in patients with proximal middle cerebral artery occlusion. It may offer a practical and widely accessible alternative to perfusion imaging for identifying candidates for reperfusion therapy beyond the standard time window.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.053277","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T10:00:57Z","timestamp":1769680857000},"page":"982-991","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["FLAIR Vascular Hyperintensities\/DWI Mismatch Predicts Penumbra in Proximal Middle Cerebral Artery Occlusion"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2979-6507","authenticated-orcid":true,"given":"Mary","family":"Boullet","sequence":"first","affiliation":[{"name":"Department of Neurology (M.B., A.B., M.F.B., P.B., S.D., M.P., P.R., S.S., V.L., I.S., S.O.), Bordeaux University Hospital, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7611-7753","authenticated-orcid":true,"given":"Gaultier","family":"Marnat","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology (G.M., T.T.), Bordeaux University Hospital, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Boyer","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.B., A.B., M.F.B., P.B., S.D., M.P., P.R., S.S., V.L., I.S., S.O.), Bordeaux University Hospital, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu F.","family":"Bastide","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.B., A.B., M.F.B., P.B., S.D., M.P., P.R., S.S., V.L., I.S., S.O.), Bordeaux University Hospital, 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