Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial
| Autor: | Louise Bonnet, Sven Poli, Janos Lückl, Charles MELLERIO, Salvador Pedraza, Laurent Derex, Matthias Endres, Jason Appleton, Jochen B. Fiebach, Jakob Møller Hansen, Helle Klingenberg Iversen, Elena Meseguer, Peter Vanacker, Anke Wouters, Götz Thomalla, Hanne Christensen, Ann De Smedt, Vincent Thijs, Thierry Moulin, Natalia Pérez de la Ossa, Laurence Legrand, Team3 Carmen, Ivana Galinovic, Simon Fandler-Höfler |
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| Přispěvatelé: | ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Neurology, ACS - Microcirculation, Radiology and Nuclear Medicine, Graduate School, Yperzeele, Laetitia, WAKE-UP Investigators, UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service de radiologie - résonance magnétique, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, Clinical sciences, Neuroprotection & Neuromodulation |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_treatment Fluid-attenuated inversion recovery Tissue Plasminogen Activator/therapeutic use surgery Modified Rankin Scale magnetic resonance imaging Thrombolytic Therapy humans Stroke medicine.diagnostic_test Thrombolysis Stroke volume ASSOCIATION Middle Aged Tissue Plasminogen Activator Acute Disease Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine ACUTE STROKE SYMPTOM ONSET medicine.medical_specialty Neuroscience(all) Clinical Neurology Lesion Double-Blind Method PREDICT TIME Internal medicine Brain Ischemia/diagnostic imaging medicine Humans Aged Advanced and Specialized Nursing Science & Technology business.industry neurology Magnetic resonance imaging medicine.disease Hyperintensity brain ischemia Diffusion Magnetic Resonance Imaging Peripheral Vascular Disease stroke volume Cardiovascular System & Cardiology Neurology (clinical) Neurosciences & Neurology Human medicine business logistic models Stroke/diagnostic imaging |
| Zdroj: | Stroke, 51(1), 209-215. Lippincott Williams and Wilkins Stroke WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis inWake-Up Stroke Trial) investigators and administrative staff are as follows: 2020, ' Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial ', Stroke, vol. 51, no. 1, pp. 209-215 . https://doi.org/10.1161/STROKEAHA.119.027390 Stroke, Vol. 51, no. 1, p. 209-215 (2020) |
| ISSN: | 0039-2499 1524-4628 |
| DOI: | 10.1161/STROKEAHA.119.027390 |
| Popis: | Background and Purpose— Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase. Methods— FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume. Results— FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKE-UP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 ( P =0.169) and shift analysis ( P =0.086) but reached significance for mRS score of 0 to 2 ( P =0.004). We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI. Conclusions— In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset. |
| Databáze: | OpenAIRE |
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