Automated DWI analysis can identify patients within the thrombolysis time window of 4.5 hours

ObjectiveTo develop an automated model based on diffusion-weighted imaging (DWI) to detect patients within 4.5 hours after stroke onset and compare this method to the visual DWI-FLAIR (fluid-attenuated inversion recovery) mismatch.MethodsWe performed a subanalysis of the “DWI-FLAIR mismatch for the identification of patients with acute ischemic stroke within 4.5 hours of symptom onset” (PRE-FLAIR) and the “AX200 for ischemic stroke” (AXIS 2) trials. We developed a prediction model with data from the PRE-FLAIR study by backward logistic regression with the 4.5-hour time window as dependent variable and the following explanatory variables: age and median relative DWI (rDWI) signal intensity, interquartile range (IQR) rDWI signal intensity, and volume of the core. We obtained the accuracy of the model to predict the 4.5-hour time window and validated our findings in an independent cohort from the AXIS 2 trial. We compared the receiver operating characteristic curve to the visual DWI-FLAIR mismatch.ResultsIn the derivation cohort of 118 patients, we retained the IQR rDWI as explanatory variable. A threshold of 0.39 was most optimal in selecting patients within 4.5 hours after stroke onset resulting in a sensitivity of 76% and specificity of 63%. The accuracy was validated in an independent cohort of 200 patients. The predictive value of the area under the curve of 0.72 (95% confidence interval 0.64–0.80) was similar to the visual DWI-FLAIR mismatch (area under the curve = 0.65; 95% confidence interval 0.58–0.72; p for difference = 0.18).ConclusionsAn automated analysis of DWI performs at least as good as the visual DWI-FLAIR mismatch in selecting patients within the 4.5-hour time window.

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Abstract W P32: Association of Low Cerebral Blood Volume With Negative FLAIR Hyperintensity in Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp32 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nandakumar Nagaraja ◽

Marie Luby ◽

Matthew Edwardson ◽

Ramin Zand ◽

Lawrence L Latour

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Volume ◽

Early Phase ◽

Cerebral Blood Volume ◽

Time Window ◽

Linear Regression Analysis ◽

Onset Time ◽

Stroke Onset ◽

Imaging Biomarker

Objective: FLAIR hyperintensity is being used in clinical trials as a surrogate imaging biomarker for stroke onset time to test the safety of thrombolysis. Studies have shown that patients with negative and positive FLAIR hyperintensity overlap at similar time points from stroke onset in the early phase of acute ischemic stroke (AIS). Hyperintensity on FLAIR MRI likely represents increased tissue water content. We sought to determine if cerebral blood volume (CBV) mediates FLAIR hyperintensity in the early phase of AIS. Methods: AIS patients seen in 2012 were included in the study if i) onset time was known, ii) an MRI with perfusion was performed within 12 hours of onset time, iii) had imaging confirmed vascular occlusion of ICA, M1, or M2. Following co-registration of raw perfusion images with FLAIR, CBV maps were generated using PMA ASIST™ software. Two raters blinded to clinical information separately evaluated the DWI, FLAIR and CBV maps and measured the signal intensity ratio (SIR) for the brightest region on FLAIR normalized by homologous contra-lateral tissue. The SIR was similarly measured for CBV in same region. FLAIR negative was defined as SIR<1.15, “Low CBV” was defined as CBV SIR <0.5. Results: One hundred eighty two patients were screened and 30 met all study criteria; 21 women, with mean age of 71 (± 16) years and median NIHSS 18 (IQR 9-22). Using linear regression analysis, CBV SIR was associated with FLAIR SIR (p <0.049). In the 0-3hr time window, overall CBV was not associated with FLAIR hyperintensity. However, in the 3-7.5hr time window, patients with negative FLAIR were more likely to have low CBV and conversely, patients with positive FLAIR were more likely to have normal CBV. Conclusion: CBV likely mediates FLAIR hyperintensity in 3-7.5hr of stroke onset but it has less impact on FLAIR hyperintensity in the first 3 hours of AIS. Low CBV could be a potential surrogate imaging biomarker in addition to FLAIR hyperintensity in the early phase of AIS.

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Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017195 ◽

2021 ◽

pp. neurintsurg-2020-017195

Author(s):

Yuko Kataoka ◽

Kazutaka Sonoda ◽

Jun C Takahashi ◽

Hatsue Ishibashi-Ueda ◽

Kazunori Toyoda ◽

...

Keyword(s):

Ischemic Stroke ◽

Malignant Tumors ◽

Characteristic Curve ◽

Cerebral Arteries ◽

Treatment Strategies ◽

Area Under The Curve ◽

Histopathological Analysis ◽

Thrombotic Risk ◽

Patients With Cancer ◽

Auc Value

BackgroundThe procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer.MethodsWe studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson’s trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares.ResultsOf the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80).ConclusionsThromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.

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Predicting Early Mortality of Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.022863 ◽

2019 ◽

Vol 50 (2) ◽

pp. 349-356 ◽

Cited By ~ 11

Author(s):

Thomas Gattringer ◽

Alexandra Posekany ◽

Kurt Niederkorn ◽

Michael Knoflach ◽

Birgit Poltrum ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Unit ◽

Functional Disability ◽

Area Under The Curve ◽

Early Mortality ◽

Stroke Severity ◽

Stroke Patients ◽

Derivation Cohort ◽

Temporal Validation

Background and Purpose— Several risk factors are known to increase mid- and long-term mortality of ischemic stroke patients. Information on predictors of early stroke mortality is scarce but often requested in clinical practice. We therefore aimed to develop a rapidly applicable tool for predicting early mortality at the stroke unit. Methods— We used data from the nationwide Austrian Stroke Unit Registry and multivariate regularized logistic regression analysis to identify demographic and clinical variables associated with early (≤7 days poststroke) mortality of patients admitted with ischemic stroke. These variables were then used to develop the Predicting Early Mortality of Ischemic Stroke score that was validated both by bootstrapping and temporal validation. Results— In total, 77 653 ischemic stroke patients were included in the analysis (median age: 74 years, 47% women). The mortality rate at the stroke unit was 2% and median stay of deceased patients was 3 days. Age, stroke severity measured by the National Institutes of Health Stroke Scale, prestroke functional disability (modified Rankin Scale >0), preexisting heart disease, diabetes mellitus, posterior circulation stroke syndrome, and nonlacunar stroke cause were associated with mortality and served to build the Predicting Early Mortality of Ischemic Stroke score ranging from 0 to 12 points. The area under the curve of the score was 0.879 (95% CI, 0.871–0.886) in the derivation cohort and 0.884 (95% CI, 0.863–0.905) in the validation sample. Patients with a score ≥10 had a 35% (95% CI, 28%–43%) risk to die within the first days at the stroke unit. Conclusions— We developed a simple score to estimate early mortality of ischemic stroke patients treated at a stroke unit. This score could help clinicians in short-term prognostication for management decisions and counseling.

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Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013083 ◽

2017 ◽

Vol 10 (3) ◽

pp. 279-284 ◽

Cited By ~ 4

Author(s):

Katsuharu Kameda ◽

Junji Uno ◽

Ryosuke Otsuji ◽

Nice Ren ◽

Shintaro Nagaoka ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Blood Volume ◽

Mechanical Thrombectomy ◽

Ct Perfusion ◽

Characteristic Curve ◽

Mean Transit Time ◽

Area Under The Curve ◽

Ischemic Penumbra ◽

Optimal Thresholds

Background and purposeOptimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT).MethodsA total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel. Optimal thresholds were calculated by performing receiver operating characteristic curve analysis in 47 patients who achieved Thrombolysis In Cerebral Infarction (TICI) grade 3 recanalization. The risk of HT after MT was evaluated in 101 patients who achieved TICI grade 2b–3 recanalization.ResultsAbsolute CTP parameters for distinguishing ischemic penumbra from ischemic core were as follows: aCBF, 27.8 mL/100 g/min (area under the curve 0.82); aCBV, 2.1 mL/100 g (0.75); and aMTT, 7.30 s (0.70). Relative CTP parameters were as follows: rCBF, 0.62 (0.81); rCBV, 0.83 (0.87); and rMTT, 1.61 (0.73). CBF was significantly lower in areas of HT than in areas of infarction (aCBF, p<0.01; rCBF, p<0.001).ConclusionsCTP may be able to predict treatable ischemic penumbra and the risk of HT after MT in patients with AIS.

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Multimodal magnetic resonance imaging to identify stroke onset within 6 h in patients with large vessel occlusions

European Stroke Journal ◽

10.1177/2396987317753486 ◽

2018 ◽

Vol 3 (2) ◽

pp. 185-192 ◽

Cited By ~ 1

Author(s):

Anke Wouters ◽

Patrick Dupont ◽

Soren Christensen ◽

Bo Norrving ◽

Rico Laage ◽

...

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Intensity Ratio ◽

Diffusion Weighted Imaging ◽

Time Window ◽

Area Under The Curve ◽

Stroke Onset ◽

Large Vessel ◽

Relative Diffusion ◽

Diffusion Weighted

Introduction Mechanical thrombectomy within 6 h after stroke onset improves the outcome in patients with large vessel occlusions. The aim of our study was to establish a model based on diffusion weighted and perfusion weighted imaging to provide an accurate prediction for the 6 h time-window in patients with unknown time of stroke onset. Patients and methods A predictive model was designed based on data from the DEFUSE 2 study and validated in a subgroup of patients with large vessel occlusions from the AXIS 2 trial. Results We constructed the model in 91 patients from DEFUSE 2. The following parameters were independently associated with <6 h time-window and included in the model: interquartile range and median relative diffusion weighted imaging, hypoperfusion intensity ratio, core volume and the interaction between median relative diffusion weighted imaging and hypoperfusion intensity ratio as predictors of the 6 h time-window. The area under the curve was 0.80 with a positive predictive value of 0.90 (95%CI 0.79–0.96). In the validation cohort (N = 90), the area under the curve was 0.73 ( P for difference = 0.4) with a positive predictive value of 0.85 (95%CI 0.69–0.95). Discussion After validation in a larger independent dataset the model can be considered to select patients for endovascular treatment in whom stroke onset is unknown. Conclusion In patients with large vessel occlusion and unknown time of stroke onset an automated multivariate imaging model is able to select patients who are likely within the 6 h time-window.

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High Level of Serum Tissue Kallikrein Is Associated with Favorable Outcome in Acute Ischemic Stroke Patients

Disease Markers ◽

10.1155/2019/5289715 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Fei Wu ◽

Yifeng Ling ◽

Lumeng Yang ◽

Xin Cheng ◽

Qiang Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Area Under The Curve ◽

Binary Logistic Regression ◽

Reperfusion Therapy ◽

Stroke Onset ◽

Tissue Kallikrein ◽

High Level

Background/Objectives. We sought to assess the association between a serum tissue kallikrein (TK) level and a 90-day outcome in acute ischemic stroke (AIS) patients who received acute reperfusion therapy. Methods. Consecutive AIS patients within 6 hours after stroke onset between December 2015 and August 2017 were prospectively recruited. Blood samples were collected before acute reperfusion therapy for serum TK measurement. Outcome was modified Rankin scale (mRS) score at 90 days after stroke onset. Binary logistic regression was performed to analyze the association between the baseline TK level and the clinical outcome. Results. Between December 2015 and August 2017, 75 patients (age range from 33 to 91 years, 72.0% male) were recruited in this study. Higher baseline TK was independently associated with a favorable functional outcome (mRS 0-2) (odds ratio 1.01, 95% confidence interval (CI) 1.00-1.02, p=0.047) and low mortality rate (odds ratio 0.98, 95% CI 0.96-1.00, p=0.049) at 90 days. Increased TK level was associated with 90 d mRS (0-2) with area under the curve of 0.719 (95% CI 0.596-0.842; p=0.002). Conclusions. Serum TK can be a promising predictor of clinical outcome in AIS patients who received acute reperfusion therapy.

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Validation of the failure to maturation equation and proposal for a novel scoring system for arteriovenous fistula maturation in multiethnic Asian haemodialysis patients

The Journal of Vascular Access ◽

10.1177/1129729819865463 ◽

2019 ◽

Vol 21 (2) ◽

pp. 169-175 ◽

Cited By ~ 1

Author(s):

Alvin Ren Kwang Tng ◽

Kian Guan Lee ◽

Ru Yu Tan ◽

Suh Chien Pang ◽

Marjorie Wai Yin Foo ◽

...

Keyword(s):

Confidence Interval ◽

Arteriovenous Fistula ◽

Odds Ratio ◽

Scoring System ◽

Characteristic Curve ◽

Area Under The Curve ◽

Success Predictors ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation

Introduction: A successful arteriovenous fistula is essential for effective haemodialysis. We aim to validate the existing failure to maturation equation and to propose a new clinical scoring system by evaluating arteriovenous fistula success predictors. Methods: Data of end-stage renal disease patients initiated on haemodialysis from January 2010 to December 2012 were retrospectively obtained from medical records with follow-up until 1 January 2014. Application of the failure to maturation equation was evaluated. A nomogram was developed using arteriovenous fistula success predictors and was calibrated with a bootstrapping technique. Results: A total of 694 patients were included with mean duration of follow-up of 2.3 years. Arteriovenous fistula maturation was achieved by 542 patients (78%). Comparing our cohort with the failure to maturation cohort, there were statistically significant differences in mean age, ethnicity and presence of diabetes mellitus. The failure to maturation equation failed to predict arteriovenous fistula outcomes with area under the curve performance of 0.519 on a receiver operating characteristic curve. Multivariate logistic regression showed that Malay patients (odds ratio = 0.628; 95% confidence interval = 0.403–0.978; p < 0.05) and patients requiring preoperative vein mapping (odds ratio = 0.601; 95% confidence interval = 0.410–0.883; p < 0.01) had a lower chance of arteriovenous fistula success, whereas male gender (odds ratio = 1.526; 95% confidence interval = 1.040–2.241; p < 0.05) and presence of postoperative good thrill (odds ratio = 3.137; 95% confidence interval = 2.127–4.625; p < 0.0001) had a higher chance of arteriovenous fistula success. The derived nomogram predicted arteriovenous fistula success (odds ratio = 1.030; 95% confidence interval = 1.022–1.038; p < 0.0001) with the area under the curve of 0.695 on a receiver operating characteristic curve and an adequacy index of 99.86% ( p < 0.0001). Conclusion: The failure to maturation equation was not validated in our cohort. The clinical utility of our proposed arteriovenous fistula scoring system requires external validation in larger studies.

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The Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Reperfusion and Prognosis after Endovascular Treatment of Acute Ischemic Stroke

Journal of Personalized Medicine ◽

10.3390/jpm11080696 ◽

2021 ◽

Vol 11 (8) ◽

pp. 696

Author(s):

Sang-Hwa Lee ◽

Min Uk Jang ◽

Yerim Kim ◽

So Young Park ◽

Chulho Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Characteristic Curve ◽

Area Under The Curve ◽

Predictive Ability ◽

Primary Outcome Measure ◽

Lymphocyte Ratio ◽

Prognostic Effect ◽

Reperfusion Rate

Background: Studies assessing the prognostic effect of inflammatory markers of blood cells on the outcomes of patients with acute ischemic stroke treated with endovascular treatment (EVT) are sparse. We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) affect reperfusion status in patients receiving EVT. Methods: Using a multicenter registry database, 282 patients treated with EVT were enrolled in this study. The primary outcome measure was unsuccessful reperfusion rate after EVT defined by thrombolysis in cerebral infarction grades 0–2a. Logistic regression analysis was performed to analyze the association between NLR/PLR and unsuccessful reperfusion rate after EVT. Results: Both NLR and PLR were higher in the unsuccessful reperfusion group than in the successful reperfusion group (p < 0.001). Multivariate analysis showed that both NLR and PLR were significantly associated with unsuccessful reperfusion (adjusted odds ratio (95% confidence interval): 1.11 (1.04–1.19), PLR: 1.004 (1.001–1.01)). The receiver operating characteristic curve showed that the predictive ability of both NLR and PLR was close to good (area under the curve (AUC) of NLR: 0.63, 95% CI (0.54–0.72), p < 0.001; AUC of PLR: 0.65, 95% CI (0.57–0.73), p < 0.001). The cutoff values of NLR and PLR were 6.2 and 103.6 for unsuccessful reperfusion, respectively. Conclusion: Higher NLR and PLR were associated with unsuccessful reperfusion after EVT. The combined application of both biomarkers could be useful for predicting outcomes after EVT.

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Abstract TMP85: Predictive Score of Hemorrhagic Transformation in Patients Not Submitted to Reperfusion Therapies - PROpHET

Stroke ◽

10.1161/str.51.suppl_1.tmp85 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joao B Andrade ◽

Gisele S Silva ◽

Jay P Mohr ◽

Joao J Carvalho ◽

Luisa Franciscatto ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Validation Cohort ◽

Characteristic Curve ◽

Reperfusion Therapy ◽

Predictive Score ◽

Brier Score ◽

Multivariable Logistic Regression Model ◽

Derivation Cohort ◽

Digital Version

Objective: To create an accurate and user-friendly pr edictive sc o re for he morrhagic t ransformation in patients not submitted to reperfusion therapies (PROpHET). Methods: We created a multivariable logistic regression model to assess the prediction of Hemorrhage Transformation (HT) for acute ischemic strokes not treated with reperfusion therapy. One point was assigned for each of gender, cardio-aortic embolism, hyperdense middle cerebral artery sign, leukoaraiosis, hyperglycemia, 2 points for ASPECTS ≤7, and -3 points for lacunar syndrome. Acute ischemic stroke patients admitted to the Fortaleza Comprehensive Stroke Center in Brazil from 2015 to 2017 were randomly selected to the derivation cohort. The validation cohort included similar, but not randomized, cases from 5 Brazilian and one American Comprehensive Stroke Centers. Symptomatic cases were defined as NIHSS ≥4 at 24 hours after the event. Results from the derivation and validation cohorts were assessed with the area under the receiver operating characteristic curve (AUC-ROC). Results: From 2,432 of acute ischemic stroke screened in Fortaleza, 448 were prospectively selected for the derivation cohort and a 7-day follow-up. From 1,847 not selected, 577 underwent reperfusion therapy, 734 were excluded due to inadequate imaging or refusal of consent, and 538 whose data were obtained retrospectively and were selected only for the validation cohort. A score ≥3 had 78% sensitivity and 75% specificity, AUC-ROC 0.82 for all cases of HT, Hosmer-Lemeshow 0.85, Brier Score 0.1, and AUC-ROC 0.83 for those with symptomatic HT. An AUC-ROC of 0.84 was found for the validation cohort of 1,910 from all 6 centers, and a score ≥3 was found in 65% of patients with HT against 11.3% of those without HT. In comparison with 8 published predictive scores of HT, PROpHET was the most accurate (p < 0.01). Conclusions: PROpHET offers a tool simple, quick and easy-to-perform to estimate risk stratification of HT in patients not submitted to RT. A digital version of PROpHET is available in www.score-prophet.com Classification of evidence: This study provides Class I evidence from prospective data acquisition.

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Abstract WP50: MRI Biomarkers in Acute Stroke: Addition of Clinical Parameters Improves the Identification of Patients Eligible for Thrombolysis

Stroke ◽

10.1161/str.47.suppl_1.wp50 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Vince I Madai ◽

Carla N Wood ◽

Ivana Galinovic ◽

Ulrike Grittner ◽

Sophie K Piper ◽

...

Keyword(s):

Acute Stroke ◽

Time Window ◽

Area Under The Curve ◽

Lesion Size ◽

Mean Value ◽

Quantitative Mri ◽

Stroke Onset ◽

Clinical Parameters ◽

Roc Curve Analysis ◽

Vessel Occlusion

Introduction: Patients with unknown time from stroke onset, e.g. in wake-up stroke, are not eligible for thrombolyic treatment. Relative signal intensities (rSI) of DWI and FLAIR MRI are biomarkers for eligibility for thrombolysis, but have shown heterogeneous results to date. We investigated if the addition of available clinical parameters improves the prediction of the thrombolysis time window in patients with acute stroke. Hypothesis: Inclusion of clinical parameters improves the prediction of the thrombolysis time window by quantitative MRI biomarkers Methods: Patients from two centers with proven stroke and stroke-onset <12 hours were included in a retrospective design. The DWI lesion was segmented and overlaid on ADC and FLAIR maps. rSI mean and standard deviation (std) were calculated: mean VOI value/mean value of the unaffected hemisphere. Prediction of the thrombolysis time window was evaluated by the area-under-the-curve (AUC) of receiver-operating-characteristic (ROC) curve analysis. Age, NIHSS, MRI field strength, lesion size, vessel occlusion and Wahlund-Score were included in adjusted and stratified regression models. Results: 82 patients were included. In the unadjusted analysis, DWI-mean and -std (AUC: 0.86, 0.87) performed best. Adjustment for clinical parameters significantly improved the performance of FLAIR-mean (0.87) and DWI-std (0.91). The best performance was found for the final stratified and adjusted models of DWI-std (0.94) and FLAIR-mean (0.96). ADC-rSIs showed no clinically acceptable performance in all models. Conclusion: rSIs of DWI and FLAIR MRI predict eligibility for thrombolysis in acute stroke with high precision, when easily available clinical parameters are included in the prediction.

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