Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics.

2022

Bonkhoff, Anna K

Ullberg, Teresa

Bretzner, Martin

Hong, Sungmin

Schirmer, Markus D

Regenhardt, Robert W

Donahue, Kathleen L

Nardin, Marco J

Dalca, Adrian V

Giese, Anne-Katrin

Etherton, Mark R

Hancock, Brandon L

Mocking, Steven J T

McIntosh, Elissa C

Attia, John

Cole, John W

Donatti, Amanda

Griessenauer, Christoph J

Heitsch, Laura

Holmegaard, Lukas

Jood, Katarina

Jimenez-Conde, Jordi

Kittner, Steven J

Lemmens, Robin

Levi, Christopher R

McDonough, Caitrin W

Meschia, James F

Phuah, Chia-Ling

Ropele, Stefan

Rosand, Jonathan

Roquer, Jaume

Rundek, Tatjana

Sacco, Ralph L

Schmidt, Reinhold

Sharma, Pankaj

Slowik, Agnieszka

Sousa, Alessandro

Stanne, Tara M

Strbian, Daniel

Tatlisumak, Turgut

Thijs, Vincent

Vagal, Achala

Woo, Daniel

Zand, Ramin

McArdle, Patrick F

Worrall, Bradford B

Jern, Christina

Lindgren, Arne G

Maguire, Jane

Wu, Ona

Frid, Petrea

Rost, Natalia S

Wasselius, Johan

Bayesian hierarchical regression

acute ischemic stroke

lesion volume

magnetic resonance imaging

multiple acute ischemic lesions

quantitative imaging

Journal Article

10.3389/fnins.2022.994458

A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort. Analyses relied upon imaging and clinical data from the international MRI-GENIE study. Imaging data comprised both Fluid-attenuated inversion recovery (FLAIR) for white matter hyperintensity (WMH) burden estimation and diffusion-weighted imaging (DWI) sequences for the assessment of acute stroke lesions. The initial step featured the systematic evaluation of occurrences of MAL within one and several vascular supply territories. Associations between MAL and important imaging and clinical characteristics were subsequently determined. The interaction effect between single and multiple lesion status and lesion volume was estimated by means of Bayesian hierarchical regression modeling for both stroke severity and functional outcome. We analyzed 2,466 patients (age = 63.4 ± 14.8, 39% women), 49.7% of which presented with a single lesion. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in multiple vascular territories. Within most territories, MAL occurred as frequently as single lesions (ratio ∼1:1). Only the brainstem region comprised fewer patients with MAL (ratio 1:4). Patients with MAL presented with a significantly higher lesion volume and acute NIHSS (7.7 vs. 1.7 ml and 4 vs. 3, p FDR < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, p FDR = 0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In case of posterior circulation stroke, lesion volume was linked to a higher NIHSS only among those with MAL. Multiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher total DWI lesion volume and a lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only.

link

Frontiers in Neuroscience 2022; 16: 994458

Frontiers in Neuroscience

1662-4548