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DWI intensity values predict FLAIR lesions in acute ischemic stroke
In acute stroke, the DWI-FLAIR mismatch allows for the allocation of patients to the thrombolysis window (
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| Published in: | PloS one 2014-03, Vol.9 (3), p.e92295-e92295 |
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| creator | Madai, Vince I Galinovic, Ivana Grittner, Ulrike Zaro-Weber, Olivier Schneider, Alice Martin, Steve Z von Samson-Himmelstjerna, Federico C Stengl, Katharina L Mutke, Matthias A Moeller-Hartmann, Walter Ebinger, Martin Fiebach, Jochen B Sobesky, Jan |
| description | In acute stroke, the DWI-FLAIR mismatch allows for the allocation of patients to the thrombolysis window ( |
| doi_str_mv | 10.1371/journal.pone.0092295 |
| format | article |
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In a retrospective, dual-center MR-imaging study we included patients with acute stroke and time-from-stroke-onset ≤12 hours (group A: n = 49, 1.5T; group B: n = 48, 3T). DW- and FLAIR-images were coregistered. The largest lesion extent in DWI defined the slice for further analysis. FLAIR-lesions were identified by 3 raters, delineated as regions-of-interest (ROIs) and copied on the DW-images. Circular ROIs were placed within the DWI-lesion and labeled according to the FLAIR-pattern (FLAIR+ or FLAIR-). ROI-values were normalized to the unaffected hemisphere. Adjusted and nonadjusted receiver-operating-characteristics (ROC) curve analysis on patient level was performed to analyze the ability of a DWI- and ADC-rSI threshold to predict the presence of FLAIR-lesions. Spearman correlation and adjusted linear regression analysis was performed to assess the relationship between DWI-intensity and time-from-stroke-onset.
DWI-rSI performed well in predicting lesions in FLAIR-imaging (mean area under the curve (AUC): group A: 0.84; group B: 0.85). An optimal mean DWI-rSI threshold was identified (A: 162%; B: 161%). ADC-maps performed worse (mean AUC: A: 0.58; B: 0.77). Adjusted regression models confirmed the superior performance of DWI-rSI. Correlation coefficents and linear regression showed a good association with time-from-stroke-onset for DWI-rSI, but not for ADC-rSI.
An easily assessable DWI-rSI threshold identifies the presence of lesions in FLAIR-imaging with good accuracy and is associated with time-from-stroke-onset in acute stroke. This finding underlines the potential of a DWI-rSI threshold as a marker of lesion age.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0092295</identifier><identifier>PMID: 24658092</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Automation ; Biology and Life Sciences ; Biomarkers ; Correlation ; Correlation analysis ; Councils ; Diffusion Magnetic Resonance Imaging - methods ; Driving while intoxicated ; Epidemiology ; Female ; Humans ; Ischemia ; Lesions ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medical imaging ; Medical research ; Medicine and Health Sciences ; Middle Aged ; Neurology ; NMR ; Nuclear magnetic resonance ; Patients ; Performance prediction ; Regression analysis ; Regression models ; Retrospective Studies ; Stroke ; Stroke - diagnosis ; Thrombolysis ; Time Factors</subject><ispartof>PloS one, 2014-03, Vol.9 (3), p.e92295-e92295</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Madai et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Madai et al 2014 Madai et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-851c2d21828ae067d015e8ed8c099cc9816a666316b1cb94e65cdb78f6a121d83</citedby><cites>FETCH-LOGICAL-c692t-851c2d21828ae067d015e8ed8c099cc9816a666316b1cb94e65cdb78f6a121d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1509205539/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1509205539?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24658092$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Baron, Jean-Claude</contributor><creatorcontrib>Madai, Vince I</creatorcontrib><creatorcontrib>Galinovic, Ivana</creatorcontrib><creatorcontrib>Grittner, Ulrike</creatorcontrib><creatorcontrib>Zaro-Weber, Olivier</creatorcontrib><creatorcontrib>Schneider, Alice</creatorcontrib><creatorcontrib>Martin, Steve Z</creatorcontrib><creatorcontrib>von Samson-Himmelstjerna, Federico C</creatorcontrib><creatorcontrib>Stengl, Katharina L</creatorcontrib><creatorcontrib>Mutke, Matthias A</creatorcontrib><creatorcontrib>Moeller-Hartmann, Walter</creatorcontrib><creatorcontrib>Ebinger, Martin</creatorcontrib><creatorcontrib>Fiebach, Jochen B</creatorcontrib><creatorcontrib>Sobesky, Jan</creatorcontrib><title>DWI intensity values predict FLAIR lesions in acute ischemic stroke</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In acute stroke, the DWI-FLAIR mismatch allows for the allocation of patients to the thrombolysis window (<4.5 hours). FLAIR-lesions, however, may be challenging to assess. In comparison, DWI may be a useful bio-marker owing to high lesion contrast. We investigated the performance of a relative DWI signal intensity (rSI) threshold to predict the presence of FLAIR-lesions in acute stroke and analyzed its association with time-from-stroke-onset.
In a retrospective, dual-center MR-imaging study we included patients with acute stroke and time-from-stroke-onset ≤12 hours (group A: n = 49, 1.5T; group B: n = 48, 3T). DW- and FLAIR-images were coregistered. The largest lesion extent in DWI defined the slice for further analysis. FLAIR-lesions were identified by 3 raters, delineated as regions-of-interest (ROIs) and copied on the DW-images. Circular ROIs were placed within the DWI-lesion and labeled according to the FLAIR-pattern (FLAIR+ or FLAIR-). ROI-values were normalized to the unaffected hemisphere. Adjusted and nonadjusted receiver-operating-characteristics (ROC) curve analysis on patient level was performed to analyze the ability of a DWI- and ADC-rSI threshold to predict the presence of FLAIR-lesions. Spearman correlation and adjusted linear regression analysis was performed to assess the relationship between DWI-intensity and time-from-stroke-onset.
DWI-rSI performed well in predicting lesions in FLAIR-imaging (mean area under the curve (AUC): group A: 0.84; group B: 0.85). An optimal mean DWI-rSI threshold was identified (A: 162%; B: 161%). ADC-maps performed worse (mean AUC: A: 0.58; B: 0.77). Adjusted regression models confirmed the superior performance of DWI-rSI. Correlation coefficents and linear regression showed a good association with time-from-stroke-onset for DWI-rSI, but not for ADC-rSI.
An easily assessable DWI-rSI threshold identifies the presence of lesions in FLAIR-imaging with good accuracy and is associated with time-from-stroke-onset in acute stroke. This finding underlines the potential of a DWI-rSI threshold as a marker of lesion age.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Automation</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers</subject><subject>Correlation</subject><subject>Correlation analysis</subject><subject>Councils</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Driving while intoxicated</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Lesions</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Patients</subject><subject>Performance prediction</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Stroke - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madai, Vince I</au><au>Galinovic, Ivana</au><au>Grittner, Ulrike</au><au>Zaro-Weber, Olivier</au><au>Schneider, Alice</au><au>Martin, Steve Z</au><au>von Samson-Himmelstjerna, Federico C</au><au>Stengl, Katharina L</au><au>Mutke, Matthias A</au><au>Moeller-Hartmann, Walter</au><au>Ebinger, Martin</au><au>Fiebach, Jochen B</au><au>Sobesky, Jan</au><au>Baron, Jean-Claude</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>DWI intensity values predict FLAIR lesions in acute ischemic stroke</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-03-21</date><risdate>2014</risdate><volume>9</volume><issue>3</issue><spage>e92295</spage><epage>e92295</epage><pages>e92295-e92295</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In acute stroke, the DWI-FLAIR mismatch allows for the allocation of patients to the thrombolysis window (<4.5 hours). FLAIR-lesions, however, may be challenging to assess. In comparison, DWI may be a useful bio-marker owing to high lesion contrast. We investigated the performance of a relative DWI signal intensity (rSI) threshold to predict the presence of FLAIR-lesions in acute stroke and analyzed its association with time-from-stroke-onset.
In a retrospective, dual-center MR-imaging study we included patients with acute stroke and time-from-stroke-onset ≤12 hours (group A: n = 49, 1.5T; group B: n = 48, 3T). DW- and FLAIR-images were coregistered. The largest lesion extent in DWI defined the slice for further analysis. FLAIR-lesions were identified by 3 raters, delineated as regions-of-interest (ROIs) and copied on the DW-images. Circular ROIs were placed within the DWI-lesion and labeled according to the FLAIR-pattern (FLAIR+ or FLAIR-). ROI-values were normalized to the unaffected hemisphere. Adjusted and nonadjusted receiver-operating-characteristics (ROC) curve analysis on patient level was performed to analyze the ability of a DWI- and ADC-rSI threshold to predict the presence of FLAIR-lesions. Spearman correlation and adjusted linear regression analysis was performed to assess the relationship between DWI-intensity and time-from-stroke-onset.
DWI-rSI performed well in predicting lesions in FLAIR-imaging (mean area under the curve (AUC): group A: 0.84; group B: 0.85). An optimal mean DWI-rSI threshold was identified (A: 162%; B: 161%). ADC-maps performed worse (mean AUC: A: 0.58; B: 0.77). Adjusted regression models confirmed the superior performance of DWI-rSI. Correlation coefficents and linear regression showed a good association with time-from-stroke-onset for DWI-rSI, but not for ADC-rSI.
An easily assessable DWI-rSI threshold identifies the presence of lesions in FLAIR-imaging with good accuracy and is associated with time-from-stroke-onset in acute stroke. This finding underlines the potential of a DWI-rSI threshold as a marker of lesion age.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24658092</pmid><doi>10.1371/journal.pone.0092295</doi><tpages>e92295</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-03, Vol.9 (3), p.e92295-e92295 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| subjects | Aged Aged, 80 and over Automation Biology and Life Sciences Biomarkers Correlation Correlation analysis Councils Diffusion Magnetic Resonance Imaging - methods Driving while intoxicated Epidemiology Female Humans Ischemia Lesions Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medical imaging Medical research Medicine and Health Sciences Middle Aged Neurology NMR Nuclear magnetic resonance Patients Performance prediction Regression analysis Regression models Retrospective Studies Stroke Stroke - diagnosis Thrombolysis Time Factors |
| title | DWI intensity values predict FLAIR lesions in acute ischemic stroke |
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