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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
Austin Authors: Wouters, Anke;Dupont, Patrick;Norrving, Bo;Laage, Rico;Thomalla, Götz;Albers, Gregory W;Thijs, Vincent;Lemmens, Robin
Affiliation: Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium
KU Leuven-University of Leuven, Leuven, Belgium
VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
Department of Clinical Sciences, Section of Neurology, Lund University, Sweden
Guided Development GmbH, Heidelberg, Germany
Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany
Stroke Center, Stanford University, Palo Alto, CA
Department of Neurology Austin Health, Heidelberg, Victoria, Australia
Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Issue Date: 1-Oct-2016 2016-09-06
Publication information: Stroke 2016; 47(10): 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 intensity was calculated in the region of nonreperfused core. Mean Tmax was calculated in the total region with Tmax >6 s. Mean relative FLAIR, mean Tmax, lesion volume with Tmax >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 Tmax 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.
DOI: 10.1161/STROKEAHA.116.013903
PubMed URL:
Type: Journal Article
Subjects: Fluid-attenuated inversion recovery imaging
Perfusion imaging
Appears in Collections:Journal articles

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