scholarly journals Diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch is associated with better neurologic response to intravenous thrombolytic therapy in acute ischemic stroke patients

2015 ◽  
Vol 2 (1) ◽  
pp. 31-37
Author(s):  
Jong Yeong Jeong ◽  
Sang Kuk Han ◽  
Dong Hyuk Shin ◽  
Ji Ung Na ◽  
Hyun Jung Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Diffusion Weighted Imaging ◽  
Inversion Recovery ◽  
Stroke Patients ◽  
Diffusion Weighted ◽  
Fluid Attenuated Inversion Recovery

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.

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.

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.

scholarly journals Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch

2017 ◽  
Vol 13 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Götz Thomalla ◽  
Florent Boutitie ◽  
Jochen B Fiebach ◽  
Claus Z Simonsen ◽  
Salvador Pedraza ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Diffusion Weighted Imaging ◽  
Clinical Characteristics ◽  
Controlled Trial ◽  
Inversion Recovery ◽  
Stroke Patients ◽  
Unique Identifier ◽  
Symptom Recognition ◽  
Diffusion Weighted ◽  
Fluid Attenuated Inversion Recovery

Background Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch. Results Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups. Conclusions There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01525290; URL: https://www.clinicaltrialsregister.eu . Unique identifier: 2011-005906-32.

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