Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion
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Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion. / Scheldeman, Lauranne; Wouters, Anke; Dupont, Patrick; Christensen, Soren; Boutitie, Florent; Cheng, Bastian; Ebinger, Martin; Endres, Matthias; Fiebach, Jochen B; Gerloff, Christian; Muir, Keith W; Nighoghossian, Norbert; Pedraza, Salvador; Simonsen, Claus Z; Ringelstein, Erich B; Chamorro, Angel; Grond, Martin; Laage, Rico; Schneider, Armin; Thomalla, Götz; Thijs, Vincent; Lemmens, Robin.
in: STROKE, Jahrgang 52, Nr. 7, 07.2021, S. 2338-2346.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion
AU - Scheldeman, Lauranne
AU - Wouters, Anke
AU - Dupont, Patrick
AU - Christensen, Soren
AU - Boutitie, Florent
AU - Cheng, Bastian
AU - Ebinger, Martin
AU - Endres, Matthias
AU - Fiebach, Jochen B
AU - Gerloff, Christian
AU - Muir, Keith W
AU - Nighoghossian, Norbert
AU - Pedraza, Salvador
AU - Simonsen, Claus Z
AU - Ringelstein, Erich B
AU - Chamorro, Angel
AU - Grond, Martin
AU - Laage, Rico
AU - Schneider, Armin
AU - Thomalla, Götz
AU - Thijs, Vincent
AU - Lemmens, Robin
PY - 2021/7
Y1 - 2021/7
N2 - Background and Purpose: We aimed to investigate fluid-attenuated inversion recovery changes in the penumbra.Methods: We determined core and perfusion lesions in subjects from the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke) and AXIS 2 trial (Granulocyte Colony-Stimulating Factor in Patients With Acute Ischemic Stroke) with perfusion- and diffusion-weighted imaging at baseline. Only subjects with a mismatch volume >15 mL and ratio >1.2 were included. We created voxel-based relative fluid-attenuated inversion recovery signal intensity (rFLAIR SI) maps at baseline and follow-up. We studied rFLAIR SI in 2 regions of interest: baseline penumbra (baseline perfusion lesion−[core lesion+voxels with apparent diffusion coefficient <620 10−6 mm2/s]) and noninfarcted penumbra (baseline perfusion lesion−follow-up fluid-attenuated inversion recovery lesion) at 24 hours (WAKE-UP) or 30 days (AXIS 2). We analyzed the association between rFLAIR SI and severity of hypoperfusion, defined as time to maximum of the residue function.Results: In the baseline penumbra, rFLAIR SI was elevated (ratio, 1.04; P=1.7×10−13; n=126) and correlated with severity of hypoperfusion (Pearson r, 0.03; P<1.0×10−4; n=126). In WAKE-UP, imaging at 24 hours revealed a further increase of rFLAIR SI in the noninfarcted penumbra (ratio, 1.05 at 24 hours versus 1.03 at baseline; P=7.1×10−3; n=43). In AXIS 2, imaging at 30 days identified reversibility of the rFLAIR SI (ratio, 1.02 at 30 days versus 1.04 at baseline; P=1.5×10−3; n=26) since it was no longer different from 1 (ratio, 1.01 at 30 days; P=0.099; n=26).Conclusions: Penumbral rFLAIR SI increases appear early after stroke onset, correlate with severity of hypoperfusion, further increase at 24 hours, and are reversible by 30 days.Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01525290. URL: https://clinicaltrials.gov; Unique identifier: NCT00927836.
AB - Background and Purpose: We aimed to investigate fluid-attenuated inversion recovery changes in the penumbra.Methods: We determined core and perfusion lesions in subjects from the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke) and AXIS 2 trial (Granulocyte Colony-Stimulating Factor in Patients With Acute Ischemic Stroke) with perfusion- and diffusion-weighted imaging at baseline. Only subjects with a mismatch volume >15 mL and ratio >1.2 were included. We created voxel-based relative fluid-attenuated inversion recovery signal intensity (rFLAIR SI) maps at baseline and follow-up. We studied rFLAIR SI in 2 regions of interest: baseline penumbra (baseline perfusion lesion−[core lesion+voxels with apparent diffusion coefficient <620 10−6 mm2/s]) and noninfarcted penumbra (baseline perfusion lesion−follow-up fluid-attenuated inversion recovery lesion) at 24 hours (WAKE-UP) or 30 days (AXIS 2). We analyzed the association between rFLAIR SI and severity of hypoperfusion, defined as time to maximum of the residue function.Results: In the baseline penumbra, rFLAIR SI was elevated (ratio, 1.04; P=1.7×10−13; n=126) and correlated with severity of hypoperfusion (Pearson r, 0.03; P<1.0×10−4; n=126). In WAKE-UP, imaging at 24 hours revealed a further increase of rFLAIR SI in the noninfarcted penumbra (ratio, 1.05 at 24 hours versus 1.03 at baseline; P=7.1×10−3; n=43). In AXIS 2, imaging at 30 days identified reversibility of the rFLAIR SI (ratio, 1.02 at 30 days versus 1.04 at baseline; P=1.5×10−3; n=26) since it was no longer different from 1 (ratio, 1.01 at 30 days; P=0.099; n=26).Conclusions: Penumbral rFLAIR SI increases appear early after stroke onset, correlate with severity of hypoperfusion, further increase at 24 hours, and are reversible by 30 days.Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01525290. URL: https://clinicaltrials.gov; Unique identifier: NCT00927836.
U2 - 10.1161/STROKEAHA.120.033071
DO - 10.1161/STROKEAHA.120.033071
M3 - SCORING: Journal article
C2 - 33980046
VL - 52
SP - 2338
EP - 2346
JO - STROKE
JF - STROKE
SN - 0039-2499
IS - 7
ER -
