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Overestimation of ischemic core on baseline MRI in acute stroke
In patients with acute ischemic stroke (AIS), overestimation of ischemic core on MRI-DWI has been described primarily in regions with milder reduced diffusion. We aimed to assess the possibility of ischemic core overestimation on pretreatment MRI despite using more restricted reduced diffusion (appa...
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Published in: | Interventional neuroradiology 2024-01, p.15910199231224500 |
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description | In patients with acute ischemic stroke (AIS), overestimation of ischemic core on MRI-DWI has been described primarily in regions with milder reduced diffusion. We aimed to assess the possibility of ischemic core overestimation on pretreatment MRI despite using more restricted reduced diffusion (apparent diffusion coefficient (ADC) ≤620 × 10
mm
) in AIS patients with successful reperfusion.
In this retrospective single institutional study, AIS patients who had pretreatment MRI underwent successful reperfusion and had follow-up MRI to determine the final infarct volume were reviewed. Pretreatment ischemic core and final infarction volumes were calculated. Ghost core was defined as overestimation of final infarct volume by baseline MRI of >10 mL. Baseline clinical, demographic, and treatment-related factors in this cohort were reviewed.
A total of 6/156 (3.8%) patients had overestimated ischemic core volume on baseline MRI, with mean overestimation of 65.6 mL. Three out of six patients had pretreatment ischemic core estimation of >70 mL, while the final infarct volume was |
doi_str_mv | 10.1177/15910199231224500 |
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mm
) in AIS patients with successful reperfusion.
In this retrospective single institutional study, AIS patients who had pretreatment MRI underwent successful reperfusion and had follow-up MRI to determine the final infarct volume were reviewed. Pretreatment ischemic core and final infarction volumes were calculated. Ghost core was defined as overestimation of final infarct volume by baseline MRI of >10 mL. Baseline clinical, demographic, and treatment-related factors in this cohort were reviewed.
A total of 6/156 (3.8%) patients had overestimated ischemic core volume on baseline MRI, with mean overestimation of 65.6 mL. Three out of six patients had pretreatment ischemic core estimation of >70 mL, while the final infarct volume was <70 mL. All six patients had last known well-to-imaging <120 min, median (IQR): 65 (53-81) minutes.
Overestimation of ischemic core, known as ghost core, is rare using severe ADC threshold (≤620 × 10
mm
), but it does occur in nearly 1 of every 25 patients, confined to hyperacute patients imaged within 120 min of symptom onset. Awareness of this phenomenon carries implications for treatment and trial enrollment.</description><identifier>ISSN: 1591-0199</identifier><identifier>ISSN: 2385-2011</identifier><identifier>EISSN: 2385-2011</identifier><identifier>DOI: 10.1177/15910199231224500</identifier><identifier>PMID: 38258456</identifier><language>eng</language><publisher>United States: SAGE Publications</publisher><subject>Original</subject><ispartof>Interventional neuroradiology, 2024-01, p.15910199231224500</ispartof><rights>The Author(s) 2024 2024 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-c39f2400dfa809f632d4686e476a5cb57aac0fc38a0bd7bda8dd3eff0f2db7173</citedby><cites>FETCH-LOGICAL-c400t-c39f2400dfa809f632d4686e476a5cb57aac0fc38a0bd7bda8dd3eff0f2db7173</cites><orcidid>0009-0001-0037-1878</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38258456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McArthur, M A</creatorcontrib><creatorcontrib>Tavakkol, E</creatorcontrib><creatorcontrib>Bahr-Hosseini, M</creatorcontrib><creatorcontrib>Jahan, R</creatorcontrib><creatorcontrib>Duckwiler, G R</creatorcontrib><creatorcontrib>Saver, J L</creatorcontrib><creatorcontrib>Liebeskind, D S</creatorcontrib><creatorcontrib>Nael, K</creatorcontrib><title>Overestimation of ischemic core on baseline MRI in acute stroke</title><title>Interventional neuroradiology</title><addtitle>Interv Neuroradiol</addtitle><description>In patients with acute ischemic stroke (AIS), overestimation of ischemic core on MRI-DWI has been described primarily in regions with milder reduced diffusion. We aimed to assess the possibility of ischemic core overestimation on pretreatment MRI despite using more restricted reduced diffusion (apparent diffusion coefficient (ADC) ≤620 × 10
mm
) in AIS patients with successful reperfusion.
In this retrospective single institutional study, AIS patients who had pretreatment MRI underwent successful reperfusion and had follow-up MRI to determine the final infarct volume were reviewed. Pretreatment ischemic core and final infarction volumes were calculated. Ghost core was defined as overestimation of final infarct volume by baseline MRI of >10 mL. Baseline clinical, demographic, and treatment-related factors in this cohort were reviewed.
A total of 6/156 (3.8%) patients had overestimated ischemic core volume on baseline MRI, with mean overestimation of 65.6 mL. Three out of six patients had pretreatment ischemic core estimation of >70 mL, while the final infarct volume was <70 mL. All six patients had last known well-to-imaging <120 min, median (IQR): 65 (53-81) minutes.
Overestimation of ischemic core, known as ghost core, is rare using severe ADC threshold (≤620 × 10
mm
), but it does occur in nearly 1 of every 25 patients, confined to hyperacute patients imaged within 120 min of symptom onset. Awareness of this phenomenon carries implications for treatment and trial enrollment.</description><subject>Original</subject><issn>1591-0199</issn><issn>2385-2011</issn><issn>2385-2011</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNplUMtOwzAQtBCIlsIHcEE5cgl4_YiTU4UqXlJRJQRny3FsakjiYieV-HtStVQgTrvanZndGYTOAV8BCHENvAAMRUEoEMI4xgdoTGjOU4IBDtF4s083gBE6ifEd44zTAo7RiOaE54xnYzRdrE0wsXON6pxvE28TF_XSNE4n2geTDLNSRVO71iRPz4-JaxOl-84ksQv-w5yiI6vqaM52dYJe725fZg_pfHH_OLuZp5ph3KWaFpYMXWVVjgubUVKxLM8ME5niuuRCKY2tprnCZSXKSuVVRY212JKqFCDoBE23uqu-bEylTdsFVctVGB4PX9IrJ_9uWreUb34tAbgAymBQuNwpBP_ZD5ZlMzg1da1a4_soSQEizxjFbIDCFqqDjzEYu78DWG6Sl_-SHzgXvx_cM36ipt9ae38h</recordid><startdate>20240123</startdate><enddate>20240123</enddate><creator>McArthur, M A</creator><creator>Tavakkol, E</creator><creator>Bahr-Hosseini, M</creator><creator>Jahan, R</creator><creator>Duckwiler, G R</creator><creator>Saver, J L</creator><creator>Liebeskind, D S</creator><creator>Nael, K</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0009-0001-0037-1878</orcidid></search><sort><creationdate>20240123</creationdate><title>Overestimation of ischemic core on baseline MRI in acute stroke</title><author>McArthur, M A ; Tavakkol, E ; Bahr-Hosseini, M ; Jahan, R ; Duckwiler, G R ; Saver, J L ; Liebeskind, D S ; Nael, K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-c39f2400dfa809f632d4686e476a5cb57aac0fc38a0bd7bda8dd3eff0f2db7173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Original</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McArthur, M A</creatorcontrib><creatorcontrib>Tavakkol, E</creatorcontrib><creatorcontrib>Bahr-Hosseini, M</creatorcontrib><creatorcontrib>Jahan, R</creatorcontrib><creatorcontrib>Duckwiler, G R</creatorcontrib><creatorcontrib>Saver, J L</creatorcontrib><creatorcontrib>Liebeskind, D S</creatorcontrib><creatorcontrib>Nael, K</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Interventional neuroradiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McArthur, M A</au><au>Tavakkol, E</au><au>Bahr-Hosseini, M</au><au>Jahan, R</au><au>Duckwiler, G R</au><au>Saver, J L</au><au>Liebeskind, D S</au><au>Nael, K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Overestimation of ischemic core on baseline MRI in acute stroke</atitle><jtitle>Interventional neuroradiology</jtitle><addtitle>Interv Neuroradiol</addtitle><date>2024-01-23</date><risdate>2024</risdate><spage>15910199231224500</spage><pages>15910199231224500-</pages><issn>1591-0199</issn><issn>2385-2011</issn><eissn>2385-2011</eissn><abstract>In patients with acute ischemic stroke (AIS), overestimation of ischemic core on MRI-DWI has been described primarily in regions with milder reduced diffusion. We aimed to assess the possibility of ischemic core overestimation on pretreatment MRI despite using more restricted reduced diffusion (apparent diffusion coefficient (ADC) ≤620 × 10
mm
) in AIS patients with successful reperfusion.
In this retrospective single institutional study, AIS patients who had pretreatment MRI underwent successful reperfusion and had follow-up MRI to determine the final infarct volume were reviewed. Pretreatment ischemic core and final infarction volumes were calculated. Ghost core was defined as overestimation of final infarct volume by baseline MRI of >10 mL. Baseline clinical, demographic, and treatment-related factors in this cohort were reviewed.
A total of 6/156 (3.8%) patients had overestimated ischemic core volume on baseline MRI, with mean overestimation of 65.6 mL. Three out of six patients had pretreatment ischemic core estimation of >70 mL, while the final infarct volume was <70 mL. All six patients had last known well-to-imaging <120 min, median (IQR): 65 (53-81) minutes.
Overestimation of ischemic core, known as ghost core, is rare using severe ADC threshold (≤620 × 10
mm
), but it does occur in nearly 1 of every 25 patients, confined to hyperacute patients imaged within 120 min of symptom onset. Awareness of this phenomenon carries implications for treatment and trial enrollment.</abstract><cop>United States</cop><pub>SAGE Publications</pub><pmid>38258456</pmid><doi>10.1177/15910199231224500</doi><orcidid>https://orcid.org/0009-0001-0037-1878</orcidid><oa>free_for_read</oa></addata></record> |
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title | Overestimation of ischemic core on baseline MRI in acute stroke |
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