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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

Wouters, Anke; Dupont, Patrick; Norrving, Bo LU ; Laage, Rico; Thomalla, Götz; Albers, Gregory W.; Thijs, Vincent and Lemmens, Robin (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.

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author
organization
publishing date
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
  • 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
2017-07-02 04:55:20
@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 &gt;6 s. Mean relative FLAIR, mean T max, lesion volume with T max &gt;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&lt;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},
  keyword      = {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},
  volume       = {47},
  year         = {2016},
}