Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22021
Title: Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial.
Authors: Cheng, Bastian;Boutitie, Florent;Nickel, Alina;Wouters, Anke;Cho, Tae-Hee;Ebinger, Martin;Endres, Matthias;Fiebach, Jochen B;Fiehler, Jens;Galinovic, Ivana;Puig, Josep;Thijs, Vincent N;Lemmens, Robin;Muir, Keith W;Nighoghossian, Norbert;Pedraza, Salvador;Simonsen, Claus Z;Gerloff, Christian;Thomalla, Götz
Affiliation: Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany
CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Germany
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany
Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany
Service de Biostatistique, Hospices Civils de Lyon, France
Université Lyon 1, Villeurbanne, France
Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, France
Hospices Civils de Lyon, France
Department of Neurology, University Hospitals Leuven, Belgium
Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium
VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium
From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany
Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Germany
Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain
Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom
Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain
Department of Neurology, Aarhus University Hospital, Denmark
From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany
Issue Date: 30-Oct-2019
EDate: 2019
Citation: Stroke 2019: STROKEAHA119027390
Abstract: Background and Purpose- Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase. Methods- FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume. Results- FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKE-UP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 (P=0.169) and shift analysis (P=0.086) but reached significance for mRS score of 0 to 2 (P=0.004). We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI. Conclusions- In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22021
DOI: 10.1161/STROKEAHA.119.027390
ORCID: 0000-0002-6614-8417
PubMed URL: 31662118
Type: Journal Article
Subjects: brain ischemia
humans
logistic models
magnetic resonance imaging
stroke volume
Appears in Collections:Journal articles

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