Prediction of Stroke Onset is Improved by Relative Fluid-Attenuated Inversion Recovery and Perfusion Imaging Compared to the Visual Diffusion-Weighted Imaging/Fluid-Attenuated Inversion Recovery Mismatch
(2016) In Stroke: a journal of cerebral circulation 47(10). p.2559-2564- Abstract
Background and Purpose - Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters. Methods - In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal... (More)
Background and Purpose - Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters. Methods - In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal intensity was calculated in the region of nonreperfused core. Mean T max was calculated in the total region with T max >6 s. Mean relative FLAIR, mean T max, lesion volume with T max >6 s, age, site of arterial stenosis, core volume, and location of infarct were analyzed by logistic regression to predict stroke onset time before or after 4.5 hours. Results - Receiver-operating characteristic curve analysis revealed an area under the curve of 0.68 (95% confidence interval 0.59-0.78) for the visual diffusion-weighted imaging/FLAIR mismatch, thereby correctly classifying 69% of patients with an onset time before or after 4.5 hours. Age, relative FLAIR, and T max increased the accuracy significantly (P<0.01) to an area under the curve of 0.82 (95% confidence interval 0.74-0.89). This new predictive model correctly categorized 77% of patients according to stroke onset before versus after 4.5 hours. Conclusions - In patients with unknown stroke onset, the accuracy of predicting time from symptom onset within 4.5 hours is improved by obtaining relative FLAIR and perfusion imaging.
(Less)
- author
- Wouters, Anke ; Dupont, Patrick ; Norrving, Bo LU ; Laage, Rico ; Thomalla, Götz ; Albers, Gregory W. ; Thijs, Vincent and Lemmens, Robin
- organization
- publishing date
- 2016-10-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- fluid-attenuated inversion recovery imaging, perfusion imaging, prediction, thrombolysis, time-window
- in
- Stroke: a journal of cerebral circulation
- volume
- 47
- issue
- 10
- pages
- 6 pages
- publisher
- American Heart Association
- external identifiers
-
- scopus:84986238973
- pmid:27601375
- wos:000385410700029
- ISSN
- 0039-2499
- DOI
- 10.1161/STROKEAHA.116.013903
- language
- English
- LU publication?
- yes
- id
- bed0349e-cb30-4d94-8991-63fef1072469
- date added to LUP
- 2016-10-26 10:12:34
- date last changed
- 2024-04-05 07:12:12
@article{bed0349e-cb30-4d94-8991-63fef1072469,
abstract = {{<p>Background and Purpose - Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters. Methods - In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal intensity was calculated in the region of nonreperfused core. Mean T max was calculated in the total region with T max >6 s. Mean relative FLAIR, mean T max, lesion volume with T max >6 s, age, site of arterial stenosis, core volume, and location of infarct were analyzed by logistic regression to predict stroke onset time before or after 4.5 hours. Results - Receiver-operating characteristic curve analysis revealed an area under the curve of 0.68 (95% confidence interval 0.59-0.78) for the visual diffusion-weighted imaging/FLAIR mismatch, thereby correctly classifying 69% of patients with an onset time before or after 4.5 hours. Age, relative FLAIR, and T max increased the accuracy significantly (P<0.01) to an area under the curve of 0.82 (95% confidence interval 0.74-0.89). This new predictive model correctly categorized 77% of patients according to stroke onset before versus after 4.5 hours. Conclusions - In patients with unknown stroke onset, the accuracy of predicting time from symptom onset within 4.5 hours is improved by obtaining relative FLAIR and perfusion imaging.</p>}},
author = {{Wouters, Anke and Dupont, Patrick and Norrving, Bo and Laage, Rico and Thomalla, Götz and Albers, Gregory W. and Thijs, Vincent and Lemmens, Robin}},
issn = {{0039-2499}},
keywords = {{fluid-attenuated inversion recovery imaging; perfusion imaging; prediction; thrombolysis; time-window}},
language = {{eng}},
month = {{10}},
number = {{10}},
pages = {{2559--2564}},
publisher = {{American Heart Association}},
series = {{Stroke: a journal of cerebral circulation}},
title = {{Prediction of Stroke Onset is Improved by Relative Fluid-Attenuated Inversion Recovery and Perfusion Imaging Compared to the Visual Diffusion-Weighted Imaging/Fluid-Attenuated Inversion Recovery Mismatch}},
url = {{http://dx.doi.org/10.1161/STROKEAHA.116.013903}},
doi = {{10.1161/STROKEAHA.116.013903}},
volume = {{47}},
year = {{2016}},
}