scholarly journals Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion

Stroke ◽  
2021 ◽  
Author(s):  
Lauranne Scheldeman ◽  
Anke Wouters ◽  
Patrick Dupont ◽  
Soren Christensen ◽  
Florent Boutitie ◽  
...  
Keyword(s):  
Residue Function ◽  
Inversion Recovery ◽  
Unique Identifier ◽  
Link Type ◽  
Apparent Diffusion ◽  
Lesion Core ◽  
Fluid Attenuated Inversion Recovery ◽  
And Diffusion ◽  
Stimulating Factor

Background and Purpose: We aimed to investigate fluid-attenuated inversion recovery changes in the penumbra. Methods: We determined core and perfusion lesions in subjects from the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke) and AXIS 2 trial (Granulocyte Colony-Stimulating Factor in Patients With Acute Ischemic Stroke) with perfusion- and diffusion-weighted imaging at baseline. Only subjects with a mismatch volume >15 mL and ratio >1.2 were included. We created voxel-based relative fluid-attenuated inversion recovery signal intensity (rFLAIR SI) maps at baseline and follow-up. We studied rFLAIR SI in 2 regions of interest: baseline penumbra (baseline perfusion lesion−[core lesion+voxels with apparent diffusion coefficient <620 10 −6 mm 2 /s]) and noninfarcted penumbra (baseline perfusion lesion−follow-up fluid-attenuated inversion recovery lesion) at 24 hours (WAKE-UP) or 30 days (AXIS 2). We analyzed the association between rFLAIR SI and severity of hypoperfusion, defined as time to maximum of the residue function. Results: In the baseline penumbra, rFLAIR SI was elevated (ratio, 1.04; P =1.7×10 − 13 ; n=126) and correlated with severity of hypoperfusion (Pearson r, 0.03; P <1.0×10 − 4 ; n=126). In WAKE-UP, imaging at 24 hours revealed a further increase of rFLAIR SI in the noninfarcted penumbra (ratio, 1.05 at 24 hours versus 1.03 at baseline; P =7.1×10 −3 ; n=43). In AXIS 2, imaging at 30 days identified reversibility of the rFLAIR SI (ratio, 1.02 at 30 days versus 1.04 at baseline; P =1.5×10 −3 ; n=26) since it was no longer different from 1 (ratio, 1.01 at 30 days; P =0.099; n=26). Conclusions: Penumbral rFLAIR SI increases appear early after stroke onset, correlate with severity of hypoperfusion, further increase at 24 hours, and are reversible by 30 days. Registration: URL: https://clinicaltrials.gov ; Unique identifier: NCT01525290. URL: https://clinicaltrials.gov ; Unique identifier: NCT00927836.

scholarly journals Abstract P352: Reversible Relative FLAIR Signal Intensity Changes in the Penumbra Correlate With Severity of Hypoperfusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lauranne Scheldeman ◽  
Anke Wouters ◽  
Patrick Dupont ◽  
Soren Christensen ◽  
Florent Boutitie ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Signal Intensity ◽  
Residue Function ◽  
Apparent Diffusion ◽  
Lesion Core ◽  
Intensity Changes ◽  
Fluid Attenuated Inversion Recovery ◽  
Ischemic Core ◽  
And Diffusion

In ischemic stroke, the study of edema, measurable as fluid attenuated inversion recovery (FLAIR) signal increase, has mainly focused on the ischemic core and less on the surrounding penumbra. To the naked eye, no FLAIR changes are present in the penumbra. However, changes in perfusion status could induce physiological changes resulting in subtle penumbral FLAIR signal alterations. To investigate penumbral FLAIR changes, we included subjects from the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) and Granulocyte Colony-Stimulating Factor in Patients With Acute Ischemic Stroke (AXIS 2) trial with perfusion- and diffusion-weighted imaging (PWI, DWI) and FLAIR at baseline. We used RAPID software to calculate the core and perfusion lesion on DWI and PWI and selected subjects with a minimal mismatch volume (15 ml) and ratio (1.2). We created voxel-based relative FLAIR signal intensity (rFLAIR SI) maps at baseline and follow up (FU) by calculating the ratio of the FLAIR intensity in one voxel and the median FLAIR intensity in a sphere with 15 mm radius around a contralateral homologues voxel. We studied rFLAIR SI in two regions of interest: the baseline penumbra (baseline perfusion lesion - [core lesion + voxels with apparent diffusion coefficient <620 10 -6 mm 2 /s]) and the non-infarcted penumbra (baseline perfusion lesion - FU FLAIR lesion) at 24 hours (WAKE-UP) or 30 days (AXIS 2). Severity of hypoperfusion was defined as the time to maximum of the residue function. In the baseline penumbra, rFLAIR SI was elevated (ratio=1.04, p=1.7*10 -13 , n=126) and correlated with severity of hypoperfusion (Pearson’s r 0.03, p<1.0*10 -4 , n=126). At 24 hours in a subgroup from WAKE-UP, rFLAIR SI in the non-infarcted penumbra further increased (ratio=1.05 at 24h vs 1.03 at baseline, p=7.1*10 -3 , n=43). In a different subgroup from AXIS 2, this increase in rFLAIR SI was reversible (ratio=1.02 at 30d vs 1.04 at baseline, p=1.5*10 -3 n=26) since it was no longer different from 1 at 30 days (ratio=1.01 at 30 days, p=0.099, n=26). Increases in rFLAIR SI, likely representing edema, are not restricted to the ischemic core and correlate with severity of hypoperfusion in the penumbra. They appear early after stroke onset, further increase at 24 hours and are reversible by 30 days.

scholarly journals Thrombolysis With Alteplase at 0.6 mg/kg for Stroke With Unknown Time of Onset

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1530-1538 ◽  
Author(s):  
Masatoshi Koga ◽  
Haruko Yamamoto ◽  
Manabu Inoue ◽  
Koko Asakura ◽  
Junya Aoki ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Inversion Recovery ◽  
Favorable Outcome ◽  
Control Group ◽  
Open Label ◽  
Unique Identifier ◽  
Ischemic Lesion ◽  
Fluid Attenuated Inversion Recovery ◽  
Standard Medical Treatment ◽  
And Control

Background and Purpose— We assessed whether lower-dose alteplase at 0.6 mg/kg is efficacious and safe for acute fluid-attenuated inversion recovery-negative stroke with unknown time of onset. Methods— This was an investigator-initiated, multicenter, randomized, open-label, blinded-end point trial. Patients met the standard indication criteria for intravenous thrombolysis other than a time last-known-well >4.5 hours (eg, wake-up stroke). Patients were randomly assigned (1:1) to receive alteplase at 0.6 mg/kg or standard medical treatment if magnetic resonance imaging showed acute ischemic lesion on diffusion-weighted imaging and no marked corresponding hyperintensity on fluid-attenuated inversion recovery. The primary outcome was a favorable outcome (90-day modified Rankin Scale score of 0–1). Results— Following the early stop and positive results of the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke), this trial was prematurely terminated with 131 of the anticipated 300 patients (55 women; mean age, 74.4±12.2 years). Favorable outcome was comparable between the alteplase group (32/68, 47.1%) and the control group (28/58, 48.3%; relative risk [RR], 0.97 [95% CI, 0.68–1.41]; P =0.892). Symptomatic intracranial hemorrhage within 22 to 36 hours occurred in 1/71 and 0/60 (RR, infinity [95% CI, 0.06 to infinity]; P >0.999), respectively. Death at 90 days occurred in 2/71 and 2/60 (RR, 0.85 [95% CI, 0.06–12.58]; P >0.999), respectively. Conclusions— No difference in favorable outcome was seen between alteplase and control groups among patients with ischemic stroke with unknown time of onset. The safety of alteplase at 0.6 mg/kg was comparable to that of standard treatment. Early study termination precludes any definitive conclusions. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02002325.

Diagnostic Ability of Fluid-Attenuated Inversion Recovery MR Imaging to Detect Remnant or Recurrent Meningiomas after Resection

2012 ◽  
Vol 25 (2) ◽  
pp. 163-171 ◽  
Author(s):  
H. Mori ◽  
A. Kunimatsu ◽  
O. Abe ◽  
H. Sasaki ◽  
H. Takao ◽  
...  
Keyword(s):  
Qualitative Analysis ◽  
Tumor Progression ◽  
Evaluation Criteria ◽  
Region Of Interest ◽  
Inversion Recovery ◽  
Recurrent Tumor ◽  
Resection Cavity ◽  
Fluid Attenuated Inversion Recovery ◽  
Remnant Tumor

It has been suggested that a difference in signal intensity (SI) between the resection cavity and normal cerebrospinal fluid (CSF) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) in partially resected gliomas indicates subsequent or coincident tumor progression. We considered that this would hold true for resected meningiomas as well. Hence, we aimed to assess whether or not such a difference in the SI during the follow-up evaluation helps predict residual or recurrent tumor in resected meningiomas. We evaluated 63 patients with resected meningiomas. The SI within the resection cavity observed on FLAIR images was qualitatively and quantitatively assessed during follow-up. Qualitative analysis comprised visual comparison of the SI in the resection cavity with that of normal CSF by neuroradiologists. The SI in the resection cavity was quantitatively assessed by region of interest (ROI) analysis and normalized against the background noise and CSF SI. Normalized SI recorded during follow-up was compared with that recorded immediately after resection. Tumor progression was defined as a 20% or greater increase in the diameter of the longest residual or recurrent meningioma (Response Evaluation Criteria in Solid Tumors). The sensitivity and specificity of the elevated SI in the resection cavity for indicating residual or recurrent tumor were calculated. Qualitative analysis by FLAIR MRI showed that patients with remnant tumor following surgery had a prolonged SI increase in the resection cavity. Further, SI increase could not always be observed before recurrence, and both SI increase and regrowth remnant/recurrence could be detected in the same MRI examination. In resected meningiomas, leakage of tumor elements into the resection cavity, presumably tumor cells, manifests as an SI increase on FLAIR images and indicates residual or recurrent tumor. However, unlike the previous reports on partially resected gliomas, we concluded that the SI change does not always precede tumor progression or recurrence.

Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences

2000 ◽  
Vol 42 (8) ◽  
pp. 602-607 ◽  
Author(s):  
C. Oppenheim ◽  
M. Logak ◽  
D. Dormont ◽  
S. Lehéricy ◽  
R. Manaï ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Inversion Recovery ◽  
Diffusion Weighted ◽  
Fluid Attenuated Inversion Recovery ◽  
Weighted Sequences ◽  
And Diffusion

scholarly journals FLAIR MR sequence in the diagnosis and follow-up of low-grade astrocytomas

2005 ◽  
Vol 62 (7-8) ◽  
pp. 525-528 ◽  
Author(s):  
Tatjana Stosic-Opincal ◽  
Mihail Gavrilov ◽  
Srboljub Stosic ◽  
Slobodan Lavrnic ◽  
Vesna Peric ◽  
...  
Keyword(s):  
Spin Echo ◽  
Diagnostic Value ◽  
Inversion Recovery ◽  
Low Grade ◽  
Flair Imaging ◽  
Flair Sequence ◽  
Cystic Component ◽  
Fluid Attenuated Inversion Recovery ◽  
Age Range

Aim. To evaluate the sensitivity of fluid-attenuated inversion recovery (FLAIR) sequence in the diagnosis and follow-up of the patients with low-grade astrocytomas compared with T2-weighted (T2W) sequence. Methods. Twenty-four patients with biopsy- confirmed low-grade astrocytoma (age range, 15-66 years) underwent T1- weighted (T1W), T2W and FLAIR imaging with a superconducting unit 1.0 T. FLAIR images were qualitatively evaluated by comparison with T2W images by the three experienced neuroradiologists. To evaluate the diagnostic value of FLAIR, the neuroradiologists individually assessed the possibilities of the detection of lesions, as well as the possibilities of the differentiation of tumor from the surrounding edema on FLAIR vs. T2W images. Every examiner ranked FLAIR sequence vs. T2W in three degrees: worse, equal and better. Results. The comparison of FLAIR with T2W spin-echo (SE) images with regard to the detection of the lesions showed that 82.8% of FLAIR studies were superior, 17.2% were of similar diagnostic value, and none was inferior to the T2W images. The comparison of images with regard to the differentiation of tumor boundaries vs. surrounding edema showed that 92.5% of FLAIR studies were superior, 7.5% were of similar diagnostic value, and none was inferior to the T2W images. Conclusion. Our results were similar to the previous studies' results concerning the advantages of FLAIR sequence in the diagnosis of low grade astrocytomas over T2W sequence. FLAIR was better at showing different tumor components, and at distinguishing CSF from the cystic component, and the postoperative cavity, compared with T2W images. Our conclusion was that FLAIR could be routinely used in the evaluation and follow-up of low-grade astrocytomas.

scholarly journals Fluid-Attenuated Inversion Recovery and Diffusion- and Perfusion-Weighted MRI Abnormalities in 117 Consecutive Patients With Stroke Symptoms

Stroke ◽  
2001 ◽  
Vol 32 (12) ◽  
pp. 2774-2781 ◽  
Author(s):  
Candice J. Perkins ◽  
Erkan Kahya ◽  
Clemente T. Roque ◽  
Patricia E. Roche ◽  
George C. Newman
Keyword(s):  
Inversion Recovery ◽  
Fluid Attenuated Inversion Recovery ◽  
And Diffusion

scholarly journals The expansion and severity of chronic MS lesions follows a periventricular gradient

2021 ◽  
Author(s):  
samuel klistorner ◽  
Michael Barnett ◽  
Stuart Graham ◽  
Chenyu Wang ◽  
Alexander Klistorner
Keyword(s):  
Diffusion Tensor ◽  
White Matter Lesions ◽  
Longitudinal Change ◽  
Tissue Loss ◽  
Close Proximity ◽  
Lesion Core ◽  
Diffusion Tensor Images ◽  
And Diffusion ◽  
3D Flair

Background and Objectives: Expansion of chronic lesions in MS patients and recently described CSF-related gradient of tissue damage are linked to microglial activation. The aim of the current study was to investigate whether lesion expansion is associated with proximity to ventricular CSF spaces. Methods: Pre- and post-gadolinium 3D-T1, 3D FLAIR and diffusion tensor images were acquired from 36 RRMS patients. Lesional activity was analysed between baseline and 48 months at different distances from the CSF using successive 1-mm thick concentric rings radiating from the ventricles. Results: Voxel-based analysis of the rate of lesion expansion demonstrated a clear periventricular gradient decreasing away from the ventricles. This was particularly apparent when lesions of equal diameter were analysed. Periventricular lesional tissue showed higher degree of tissue distraction at baseline that significantly increased during follow-up in rings close to CSF. This longitudinal change was proportional to degree of lesion expansion. Lesion-wise analysis revealed a gradual, centrifugal decrease in the proportion of expanding lesions from the immediate periventricular zone. Discussion: Our data suggest that chronic white matter lesions in close proximity to the ventricles are more destructive, show a higher degree of expansion at the lesion border and accelerated tissue loss in the lesion core.

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.

Sign in / Sign up

Export Citation Format

Share Document