The Role of the Signal Intensity Ratio on Fluid-Attenuated Inversion Recovery in Stroke Patients Achieving Successful Recanalization with Endovascular Treatment

• Published in: Journal of stroke and cerebrovascular diseases 2017-07, Vol.26 (7), p.1528-1534
• Main Authors: Kim, Taehoon, MD, Chung, Jong-Won, MD, MSc, Jang, Myung Suk, AS, Yang, Mi Hwa, AS, Lee, Sang-Hwa, MD, Msc, Kim, Beom Joon, MD, PhD, Han, Moon-Ku, MD, PhD, Kim, Jae Hyoung, MD, PhD, Jung, Cheolkyu, MD, PhD, Lim, Jae-Sung, MD, PhD, Bae, Hee-Joon, MD, PhD, FAHA
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - diagnostic imaging; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Cardiovascular; Chi-Square Distribution; Databases, Factual; Diffusion Magnetic Resonance Imaging - methods; Disability Evaluation; Disease Progression; Endovascular Procedures - methods; endovascular treatment; Female; fluid-attenuated inversion recovery; Humans; Image Interpretation, Computer-Assisted - methods; infarct volume; Ischemic stroke; Linear Models; Logistic Models; magnetic resonance imaging; Male; Middle Aged; Multivariate Analysis; Neurology; Predictive Value of Tests; Registries; Retrospective Studies; Severity of Illness Index; Stroke - diagnostic imaging; Stroke - physiopathology; Stroke - therapy; Time Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.037

Background This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) imaging hyperintensity can be used as a surrogate marker for the severity of ischemic insult and predict lesion growth. Methods Based on a prospective stroke registry database, we identified patients with ischemic stroke who were treated with endovascular treatment (EVT) within 8 hours of onset and achieved successful recanalization (modified thrombolysis in cerebral infarction ≥2B). FLAIR hyperintensity was measured using the signal intensity ratio (SIR), defined as the mean SIR of diffusion-restricted lesions to the corresponding areas in the contralateral hemisphere. Lesion growth was defined as the ratio of final infarct volume on follow-up FLAIR to initial infarct volume on diffusion-weighted imaging. Results For 69 patients meeting the eligibility criteria, the median FLAIR SIR was 1.17 (interquartile range, 1.08-1.23) and the median lesion growth ratio was 1.70 (interquartile range, 1.35-2.79) (Pearson's r = −.146, P  = .231). In multiple linear regression models, the FLAIR SIR was not significantly correlated with the lesion growth ratio. Interestingly, the time interval from initial magnetic resonance imaging (MRI) to successful recanalization was independently correlated with the lesion growth ratio (β = .072, P