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Title: Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch.
Austin Authors: Thomalla, Götz;Boutitie, Florent;Fiebach, Jochen B;Simonsen, Claus Z;Pedraza, Salvador;Lemmens, Robin;Nighoghossian, Norbert;Roy, Pascal;Muir, Keith W;Ebinger, Martin;Ford, Ian;Cheng, Bastian;Galinovic, Ivana;Cho, Tae-Hee;Puig, Josep;Thijs, Vincent N ;Endres, Matthias;Fiehler, Jens;Gerloff, Christian
Affiliation: Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
Université Lyon 1, Villeurbanne, France
CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Department of Neurology, Hospices Civils de Lyon, Lyon, France
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investgació Biomèdica de Girona (IDIBGI), Girona, Spain
KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium
University Hospitals Leuven, Department of Neurology, Leuven, Belgium
VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Issue Date: Jan-2018 2017-04-20
Publication information: International Journal of Stroke 2018; 13(1): 66-73
Abstract: 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: . Unique identifier: NCT01525290; URL: . Unique identifier: 2011-005906-32.
DOI: 10.1177/1747493017706245
ORCID: 0000-0002-6614-8417
PubMed URL: 28425349
Type: Journal Article
Subjects: Acute
clinical trial
diffusion-weighted imaging
diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch
fluid-attenuated inversion recovery imaging
Ischaemic Stroke
Magnetic Resonance Imaging
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