Abstract W MP19: Diffusion-Weighted Imaging-Fluid-Attenuated Inversion Recovery Mismatch at 1.5T VS 3T MRI in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kenta Seki ◽  
Masatoshi Koga ◽  
Shoichiro Sato ◽  
Kazunari Homma ◽  
Sohei Yoshimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Diffusion Weighted Imaging ◽  
Inversion Recovery ◽  
Stroke Onset ◽  
Ischemic Lesion ◽  
3T Mri ◽  
Diffusion Weighted ◽  
Fluid Attenuated Inversion Recovery

Background and purpose: Although the diffusion-weighted imaging (DWI)-fluid-attenuated inversion recovery (FLAIR) mismatch (DFM) can be a surrogate marker of stroke onset time, DFM at 3T MRI may represent different clinical implications from that at 1.5T MRI. We aimed to compare the prevalence of DFM between 1.5T and 3T MRI, and assess factors associated with the FLAIR lesion positivity, and analyze a sensitivity and a specificity of DFM to identify patients ≤ 4.5h of stroke onset. Methods: Consecutive patients with acute ischemic stroke who underwent 3T or 1.5T MRI including DWI and FLAIR ≤ 12h of onset were enrolled. Random allocation regarding the magnetic field strength was performed according to the MRI availability. More than two stroke neurologists judged whether there is DFM. We identified ischemic lesion corresponding to stroke symptom on DWI and then determined whether the FLAIR lesion positivity is negative, subtle (only slightly different from adjacent parenchyma) or evident (a clearly high signal). DFM was defined as the FLAIR negative or subtle corresponding to the DWI lesion. Results: Of 179 patients (women, 39%; 72±11 years) studied, 89 and 90 received 3T and 1.5T MRI, respectively. The median onset to MRI time (OMT) was 2.5h at both 3T and 1.5T MRI. The FLAIR positivity was negative in 51% at 3T vs. 30% at 1.5T, subtle in 22% vs. 27% and evident in 27% vs. 43%, respectively (p=0.015); thus DFM was identified in 73% vs. 57% (p=0.028). On ordinal logistic regression with backward stepwise selection, 3T MRI (OR 0.40, 95%CI 0.22-0.71) and infratentorial infarction (OR 0.29, 95%CI 0.12-0.68) were negatively, and OMT (per 1h, OR 1.18, 95%CI 1.07-1.30) was positively associated with the FLAIR lesion positivity. DFM ≤ 4.5h was more frequently observed at 3T than 1.5T MRI (80% vs. 60%, p=0.015). Using DFM, patients ≤ 4.5h of onset were detected with a sensitivity of 0.80, a specificity of 0.42, a positive predictive value of 0.77 and a negative predictive value of 0.46 at 3T MRI and 0.60, 0.53, 0.82 and 0.26, respectively, at 1.5T MRI. Conclusions: DFM was more frequently observed at 3T than at 1.5T MRI. Because the FLAIR lesion was associated with 1.5T rather than 3T, DFM at 3T may have different implications regarding time after stroke onset from that at 1.5T.

Abstract T P42: Diffusion-weighted Imaging-fluid-attenuated Inversion Recovery Mismatch and Fluid-attenuated Inversion Recovery Vascular Hyperintensities in Onset Time Estimation of Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kazunari Homma ◽  
Masatoshi Koga ◽  
Sato Shoichiro ◽  
Kenta Seki ◽  
Shoei Yoshimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Diffusion Weighted Imaging ◽  
Onset Time ◽  
Inversion Recovery ◽  
Early Group ◽  
Fluid Attenuated Inversion Recovery ◽  
Late Group

Background and Purpose: The diffusion-weighted imaging (DWI)-fluid-attenuated inversion recovery (FLAIR) mismatch (DFM) is useful to estimate the onset time of stroke. The presence of FLAIR vascular hyperintensities (FVH) is associated with large diffusion-perfusion mismatch in patients with middle cerebral artery occlusion. We aimed to assess whether the combination of DFM and FVH was useful to predict patients ≤ 4.5 h after stroke onset. Methods: Consecutive patients with acute ischemic stroke who underwent 3.0T or 1.5T MRI including DWI and FLAIR within 12h after onset were registered. Of them, those with middle cerebral artery territory infarction were studied. More than two stroke neurologists judged whether there is DFM. We identified ischemic lesion corresponding to stroke symptom on DWI and then determined whether the FLAIR lesion positivity is negative, subtle (only slightly different from adjacent parenchyma) or evident (a clearly high signal). DFM was defined as the FLAIR negative or subtle corresponding to the DWI lesion. Patients were divided into two groups; the early group, those underwent MRI ≤ 4.5h after onset; and the late group, those underwent > 4.5h. Results: Of 129 patients (56 women, 72±12 years old) studied, 103 patients (45 women, 73±12 years old) and 26 patients (11 women, 70±11 years old) were assigned to the early and the late groups, respectively. Initial NIHSS score (median 7 [IQR 2-15] vs. 3.5 [1-6], p=0.032) was higher, and DFM (67% vs. 35%, p=0.003) and FVH (49% vs. 23%, p=0.019) were more frequently observed in the early group than in the late group. On multivariate analyses adjusted for confounders, DFM (odds ratio 3.35, 95% confidence interval 1.29-9.27; p=0.013) was independently associated with the early group. Patients in the early group were detected with a sensitivity of 0.67, specificity of 0.65, a positive predictive value of 0.88, and a negative predictive value of 0.33 using the presence of DFM and with 0.37, 0.92, 0.95, and 0.27, respectively, using the combination of DFM and FVH. Conclusions: DFM is useful to detect acute ischemic stroke patients ≤ 4.5h of onset with the acceptable sensitivity and specificity. Furthermore, patients with both DFM and FVH are very likely to be ≤ 4.5h of onset, although the sensitivity is low.

Reversible diffusion-weighted imaging lesions in acute ischemic stroke

Neurology ◽  
2020 ◽  
Vol 94 (13) ◽  
pp. 571-587 ◽  
Author(s):  
Nandakumar Nagaraja ◽  
John R. Forder ◽  
Steven Warach ◽  
Jośe G. Merino
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Diffusion Weighted Imaging ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Nihss Score ◽  
Diffusion Weighted ◽  
Ischemic Tissue ◽  
Fluid Attenuated Inversion Recovery

ObjectivesTo systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance.MethodsStudies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data.ResultsTwenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion.ConclusionsDWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke.

Diffusion-Weighted Imaging-Fluid-Attenuated Inversion Recovery Mismatch Is Associated with 90-Day Functional Outcomes in Patients Undergoing Mechanical Thrombectomy

2020 ◽  
Vol 49 (3) ◽  
pp. 292-300
Author(s):  
Fumihiro Sakakibara ◽  
Shinichi Yoshimura ◽  
Soichiro Numa ◽  
Kazutaka Uchida ◽  
Norito Kinjo ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Diffusion Weighted Imaging ◽  
Mechanical Thrombectomy ◽  
Inversion Recovery ◽  
Favorable Outcome ◽  
Ischemic Lesion ◽  
Historical Cohort ◽  
Diffusion Weighted ◽  
Fluid Attenuated Inversion Recovery ◽  
To Receive

Background and Purpose: Diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch is an early sign of acute ischemic stroke. DWI-FLAIR mismatch was reported to be valuable to select patients with unknown onset stroke who are eligible to receive intravenous thrombolysis (IVT), but its utility is less studied in patients undergoing mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). We thus investigated the functional outcomes at 90 days between patients with DWI-FLAIR mismatch and those with match who underwent MT for LVO. Methods: We conducted a historical cohort study in consecutive patients who were evaluated by magnetic resonance imaging for suspected stroke at a single center. We enrolled patients with occlusion of internal carotid artery or horizontal or vertical segment of middle cerebral artery who underwent MT within 24 h after they were last known to be well. DWI-FLAIR mismatch was defined when a visible acute ischemic lesion was present on DWI without traceable parenchymal hyperintensity on FLAIR. Image analysis was done by 2 stroke neurologists independently. We estimated the adjusted odds ratio (OR) of DWI-FLAIR mismatch relative to DWI-FLAIR match for moderate outcome defined as modified Rankin Scale (mRS) 0–3, favorable outcome defined as mRS 0–2 and mortality at 90 days after the onset, and symptomatic intracranial hemorrhage (sICH) within 72 h after the onset. Results: Of the 380 patients who received MT, 202 were included. Patients with DWI-FLAIR mismatch (146 [72%]) had significantly higher baseline National Institutes of Health Stroke Scale (median 16 vs. 13, p = 0.01), more transferred-in (78 vs. 63%, p = 0.02), more IVT (45 vs. 18%, p = 0.0003), more cardioembolism (69 vs. 54%, p = 0.03), and shorter onset-to-hospital door times (median 175 vs. 371 min, p < 0.0001) than patients with DWI-FLAIR match. Patients with DWI-FLAIR mismatch had more moderate outcome than those with DWI-FLAIR match (61 vs. 52%, p = 0.24), and the adjusted OR was 3.12 (95% confidence interval [CI]: 1.35–7.19, p = 0.008). sICH within 72 h was less frequent in the DWI-FLAIR mismatch group (10 vs. 20%, p = 0.06), with an adjusted OR of 0.36 (95% CI: 0.13–0.97, p = 0.044). The adjusted ORs for favorable outcome and mortality were 0.87 (95% CI: 0.39–1.94, p = 0.73) and 0.63 (95% CI: 0.20–2.05, p = 0.44), respectively. Conclusions: DWI-FLAIR mismatch was associated with more moderate outcome and less sICH in the adjusted analysis in patients receiving MT for acute LVO. DWI-FLAIR mismatch could be useful to select patients with unknown onset stroke who are eligible to receive MT for acute LVO.

scholarly journals Incidence of New Diffusion-Weighted Imaging Lesions Outside the Area of Initial Hypoperfusion Within 1 Week After Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 2654-2658 ◽  
Author(s):  
Tatiana Usnich ◽  
Fredrik N. Albach ◽  
Peter Brunecker ◽  
Jochen B. Fiebach ◽  
Christian H. Nolte
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted

Rhombencephalitis in Children: Diffusion Magnetic Resonance Imaging (MRI) Correlation With Clinical Outcomes

2020 ◽  
Vol 35 (6) ◽  
pp. 404-409
Author(s):  
Alex Mun-Ching Wong ◽  
Chih-Hua Yeh ◽  
Jainn-Jim Lin ◽  
I-Jun Chou ◽  
Kuang-Lin Lin
Keyword(s):  
Clinical Outcomes ◽  
Diffusion Weighted Imaging ◽  
Multivariate Logistic Regression Analysis ◽  
Inversion Recovery ◽  
Unfavorable Outcome ◽  
Multivariate Logistic Regression ◽  
Diffusion Weighted ◽  
Disturbance Of Consciousness ◽  
Outcome Group ◽  
Fluid Attenuated Inversion Recovery

In children with rhombencephalitis, neuroimaging abnormalities have been infrequently correlated with clinical outcome. We investigated whether magnetic resonance (MR) neuroimaging studies could predict clinical outcomes and disturbance of consciousness in patients with rhombencephalitis. We retrospectively analyzed the MR studies of 19 pediatric patients with rhombencephalitis (median age: 4.2 years, range 0.5-17; sex: 32% male). Fluid-attenuated inversion recovery imaging and diffusion-weighted imaging findings were graded to create imaging scores according to the extent of imaging abnormality. Clinical outcomes in the first week and 12th month were graded by using Glasgow Outcome Scale scores (1-5) and dichotomized to unfavorable or favorable outcome. Correlations of the imaging scores with the clinical outcomes and with disturbance of consciousness were assessed by using multivariate logistic regression analysis. No significant correlation was found between fluid-attenuated inversion recovery score or diffusion-weighted imaging score ( P = .608, P = .132, respectively) and disturbance of consciousness. In the first week, the unfavorable outcome group (n = 11) had significantly higher diffusion-weighted imaging score than did the favorable outcome group (n = 8) (Mann-Whitney U test, P = .005). Multivariate logistic regression analysis showed that the diffusion-weighted imaging score (odds ratio, 18.182; 95% confidence interval: 1.36, 243.01; P = .028) was significantly associated with unfavorable outcome. In the 12th month, the fluid-attenuated inversion recovery score or diffusion-weighted imaging score ( P = .994, P = .997, respectively) were not significantly associated with unfavorable outcome. Patients with rhombencephalitis who have a higher diffusion-weighted imaging score are more likely to have an unfavorable 1-week clinical outcome.

scholarly journals Thrombolysis Outcomes in Acute Ischemic Stroke by Fluid-Attenuated Inversion Recovery Hyperintense Arteries

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2240-2243
Author(s):  
Zien Zhou ◽  
Sohei Yoshimura ◽  
Candice Delcourt ◽  
Richard I. Lindley ◽  
Shoujiang You ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Inversion Recovery ◽  
Modified Rankin Scale ◽  
Resonance Imaging ◽  
Scale Scores ◽  
Fluid Attenuated Inversion Recovery

Background and Purpose: To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging and their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial alteplase-dose arm. Methods: Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR and diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location and extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), and other ischemic signs. Logistic regression models were used to determine predictors of FLAIR-HAs and the association of FLAIR-HAs with 90-day outcomes: favorable functional outcome (primary; modified Rankin Scale scores, 0–1), other modified Rankin Scale scores, and intracerebral hemorrhage. Results: Prior atrial fibrillation, LVO, large infarct volume, and anterior circulation infarction were independently associated with FLAIR-HAs. The rate of modified Rankin Scale scores 0 to 1 was numerically lower in patients with FLAIR-HAs versus without (69/152 [45.4%] versus 75/131 [57.3%]), as was the subset of LVO (37/93 [39.8%] versus 9/16 [56.3%]), but not in those without LVO (25/36 [69.4%] versus 60/106 [56.6%]). After adjustment for covariables, FLAIR-HAs were independently associated with increased primary outcome (adjusted odds ratio [95% CI]: overall 4.14 [1.63–10.50]; with LVO 4.92 [0.87–27.86]; no LVO 6.16 [1.57–24.14]) despite an increased risk of hemorrhagic infarct (4.77 [1.12–20.26]). Conclusions: FLAIR-HAs are more frequent in acute ischemic stroke with cardioembolic features and indicate potential for a favorable prognosis in thrombolysis-treated patients possibly mediated by LVO. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01422616.

Sign in / Sign up

Export Citation Format

Share Document