Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Clinical-Radiological Parameters Improve the Prediction of the Thrombolysis Time Window by Both MRI Signal Intensities and DWI-FLAIR Mismatch

Madai V.I.e, i · Wood C.N.f, i · Galinovic I.i · Grittner U.g, i · Piper S.K.h, i · Revankar G.S.i · Martin S.Z.i · Zaro-Weber O.a, b · Moeller-Hartmann W.d · von Samson-Himmelstjerna F.C.c, i · Heiss W.-D.a, b · Ebinger M.e, i · Fiebach J.B.i · Sobesky J.e, i

Author affiliations

aMax-Planck-Institute for Neurological Research, and bMax-Planck-Institute for Metabolism Research, Cologne, cFraunhofer MEVIS, Bremen, dKrankenhaus Ludmillenstift, Meppen, eDepartment of Neurology, fMaster Program Medical Neurosciences, gDepartment for Biostatistics and Clinical Epidemiology, hNeuroCure Clinical Research Center, and iCenter for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany

Related Articles for ""

Cerebrovasc Dis 2016;42:57-65

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 29, 2015
Accepted: February 18, 2016
Published online: March 18, 2016
Issue release date: June 2016

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background: With regard to acute stroke, patients with unknown time from stroke onset are not eligible for thrombolysis. Quantitative diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) MRI relative signal intensity (rSI) biomarkers have been introduced to predict eligibility for thrombolysis, but have shown heterogeneous results in the past. In the present work, we investigated whether the inclusion of easily obtainable clinical-radiological parameters would improve the prediction of the thrombolysis time window by rSIs and compared their performance to the visual DWI-FLAIR mismatch. Methods: In a retrospective study, patients from 2 centers with proven stroke with onset <12 h were included. The DWI lesion was segmented and overlaid on ADC and FLAIR images. rSI mean and SD, were calculated as follows: (mean ROI value/mean value of the unaffected hemisphere). Additionally, the visual DWI-FLAIR mismatch was evaluated. Prediction of the thrombolysis time window was evaluated by the area-under-the-curve (AUC) derived from receiver operating characteristic (ROC) curve analysis. Factors such as the association of age, National Institutes of Health Stroke Scale, MRI field strength, lesion size, vessel occlusion and Wahlund-Score with rSI were investigated and the models were adjusted and stratified accordingly. Results: In 82 patients, the unadjusted rSI measures DWI-mean and -SD showed the highest AUCs (AUC 0.86-0.87). Adjustment for clinical-radiological covariates significantly improved the performance of FLAIR-mean (0.91) and DWI-SD (0.91). The best prediction results based on the AUC were found for the final stratified and adjusted models of DWI-SD (0.94) and FLAIR-mean (0.96) and a multivariable DWI-FLAIR model (0.95). The adjusted visual DWI-FLAIR mismatch did not perform in a significantly worse manner (0.89). ADC-rSIs showed fair performance in all models. Conclusions: Quantitative DWI and FLAIR MRI biomarkers as well as the visual DWI-FLAIR mismatch provide excellent prediction of eligibility for thrombolysis in acute stroke, when easily obtainable clinical-radiological parameters are included in the prediction models.

© 2016 S. Karger AG, Basel


References

  1. Thomalla G, Cheng B, Ebinger M, Hao Q, Tourdias T, Wu O, et al: DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4· 5 h of symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol 2011;10:978-986.
  2. Cheng B, Brinkmann M, Forkert ND, Treszl A, Ebinger M, Köhrmann M, et al: Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset. J Cereb Blood Flow Metab 2013;33:76-84.
  3. Petkova M, Rodrigo S, Lamy C, Oppenheim G, Touzé E, Mas JL, et al: MR imaging helps predict time from symptom onset in patients with acute stroke: implications for patients with unknown onset time. Radiology 2010;257:782-792.
  4. Madai VI, Galinovic I, Grittner U, Zaro-Weber O, Schneider A, Martin SZ, et al: DWI intensity values predict FLAIR lesions in acute ischemic stroke. PLoS One 2014;9:e92295.
  5. Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, et al: RAPID automated patient selection for reperfusion therapy: a pooled analysis of the echoplanar imaging thrombolytic evaluation trial (EPITHET) and the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Stroke 2011;42:1608-1614.
  6. Forkert ND, Cheng B, Kemmling A, Thomalla G, Fiehler J: ANTONIA perfusion and stroke. A software tool for the multi-purpose analysis of MR perfusion-weighted datasets and quantitative ischemic stroke assessment. Methods Inf Med 2014;53:469-481.
  7. Cízek J, Herholz K, Vollmar S, Schrader R, Klein J, Heiss WD: Fast and robust registration of PET and MR images of human brain. NeuroImage 2004;22:434-442.
  8. Ostwaldt AC, Galinovic I, Hotter B, Grittner U, Nolte CH, Audebert HJ, et al: Relative FLAIR signal intensities over time in acute ischemic stroke: comparison of two methods. J Neuroimaging 2015;25:964-968.
  9. DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837-845.
  10. Thomalla G, Fiebach JB, Østergaard L, Pedraza S, Thijs V, Nighoghossian N, et al: A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (WAKE-UP). Int J Stroke 2014;9:829-836.
  11. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008;25:457-507.
  12. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al; Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American academy of neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007;38:1655-1711.
  13. Sobesky J: Refining the mismatch concept in acute stroke: lessons learned from PET and MRI. J Cereb Blood Flow Metab 2012;32:1416-1425.
  14. Scalzo F, Nour M, Liebeskind DS: Data science of stroke imaging and enlightenment of the penumbra. Front Neurol 2015;6:8.
  15. Xu XQ, Cheng QG, Zu QQ, Lu SS, Yu J, Sheng Y, et al: Comparative study of the relative signal intensity on DWI, FLAIR, and T2 images in identifying the onset time of stroke in an embolic canine model. Neurol Sci 2014;35:1059-1065.
  16. Galinovic I, Puig J, Neeb L, Guibernau J, Kemmling A, Siemonsen S, et al: Visual and region of interest-based inter-rater agreement in the assessment of the diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch. Stroke 2014;45:1170-1172.
  17. Thomalla G, Gerloff C: We are on the clock: MRI as a surrogate marker of lesion age in acute ischemic stroke. Stroke 2010;41:197-198.
  18. Rosso C, Drier A, Lacroix D, Mutlu G, Pires C, Lehéricy S, et al: Diffusion-weighted MRI in acute stroke within the first 6 hours: 1.5 or 3.0 tesla? Neurology 2010;74:1946-1953.
  19. Grosse-Dresselhaus F, Galinovic I, Villringer K, Audebert HJ, Fiebach JB: Difficulty of MRI based identification of lesion age by acute infra-tentorial ischemic stroke. PLoS One 2014;9:e92868.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 29, 2015
Accepted: February 18, 2016
Published online: March 18, 2016
Issue release date: June 2016

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.