Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset.
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Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset. / Cheng, Bastian; Brinkmann, Mathias; Forkert, Nils D; Treszl, Andras; Ebinger, Martin; Köhrmann, Martin; Wu, Ona; Kang, Dong-Wha; Liebeskind, David S; Tourdias, Thomas; Singer, Oliver C; Christensen, Soren; Luby, Marie; Warach, Steven; Fiehler, Jens; Fiebach, Jochen B; Gerloff, Christian; Thomalla, Götz; STIR/VISTA Imaging Collaboration.
In: J CEREBR BLOOD F MET, Vol. 33, No. 1, 1, 2013, p. 76-84.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset.
AU - Cheng, Bastian
AU - Brinkmann, Mathias
AU - Forkert, Nils D
AU - Treszl, Andras
AU - Ebinger, Martin
AU - Köhrmann, Martin
AU - Wu, Ona
AU - Kang, Dong-Wha
AU - Liebeskind, David S
AU - Tourdias, Thomas
AU - Singer, Oliver C
AU - Christensen, Soren
AU - Luby, Marie
AU - Warach, Steven
AU - Fiehler, Jens
AU - Fiebach, Jochen B
AU - Gerloff, Christian
AU - Thomalla, Götz
AU - STIR/VISTA Imaging Collaboration
PY - 2013
Y1 - 2013
N2 - In acute stroke magnetic resonance imaging, a 'mismatch' between visibility of an ischemic lesion on diffusion-weighted imaging (DWI) and missing corresponding parenchymal hyperintensities on fluid-attenuated inversion recovery (FLAIR) data sets was shown to identify patients with time from symptom onset ≤4.5 hours with high specificity. However, moderate sensitivity and suboptimal interpreter agreement are limitations of a visual rating of FLAIR lesion visibility. We tested refined image analysis methods in patients included in the previously published PREFLAIR study using refined visual analysis and quantitative measurements of relative FLAIR signal intensity (rSI) from a three-dimensional, segmented stroke lesion volume. A total of 399 patients were included. The rSI of FLAIR lesions showed a moderate correlation with time from symptom onset (r=0.382, P<0.001). A FLAIR rSI threshold of <1.0721 predicted symptom onset ≤4.5 hours with slightly increased specificity (0.85 versus 0.78) but also slightly decreased sensitivity (0.47 versus 0.58) as compared with visual analysis. Refined visual analysis differentiating between 'subtle' and 'obvious' FLAIR hyperintensities and classification and regression tree algorithms combining information from visual and quantitative analysis also did not improve diagnostic accuracy. Our results raise doubts whether the prediction of stroke onset time by visual image judgment can be improved by quantitative rSI measurements.
AB - In acute stroke magnetic resonance imaging, a 'mismatch' between visibility of an ischemic lesion on diffusion-weighted imaging (DWI) and missing corresponding parenchymal hyperintensities on fluid-attenuated inversion recovery (FLAIR) data sets was shown to identify patients with time from symptom onset ≤4.5 hours with high specificity. However, moderate sensitivity and suboptimal interpreter agreement are limitations of a visual rating of FLAIR lesion visibility. We tested refined image analysis methods in patients included in the previously published PREFLAIR study using refined visual analysis and quantitative measurements of relative FLAIR signal intensity (rSI) from a three-dimensional, segmented stroke lesion volume. A total of 399 patients were included. The rSI of FLAIR lesions showed a moderate correlation with time from symptom onset (r=0.382, P<0.001). A FLAIR rSI threshold of <1.0721 predicted symptom onset ≤4.5 hours with slightly increased specificity (0.85 versus 0.78) but also slightly decreased sensitivity (0.47 versus 0.58) as compared with visual analysis. Refined visual analysis differentiating between 'subtle' and 'obvious' FLAIR hyperintensities and classification and regression tree algorithms combining information from visual and quantitative analysis also did not improve diagnostic accuracy. Our results raise doubts whether the prediction of stroke onset time by visual image judgment can be improved by quantitative rSI measurements.
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Sensitivity and Specificity
KW - Predictive Value of Tests
KW - Time Factors
KW - Algorithms
KW - Data Interpretation, Statistical
KW - Image Interpretation, Computer-Assisted
KW - Diffusion Magnetic Resonance Imaging
KW - Stroke/diagnosis
KW - Cerebrovascular Circulation/physiology
KW - Blood Volume/physiology
KW - Brain/blood supply
KW - Microvessels/physiology
KW - Symptom Assessment/methods
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Sensitivity and Specificity
KW - Predictive Value of Tests
KW - Time Factors
KW - Algorithms
KW - Data Interpretation, Statistical
KW - Image Interpretation, Computer-Assisted
KW - Diffusion Magnetic Resonance Imaging
KW - Stroke/diagnosis
KW - Cerebrovascular Circulation/physiology
KW - Blood Volume/physiology
KW - Brain/blood supply
KW - Microvessels/physiology
KW - Symptom Assessment/methods
U2 - 10.1038/jcbfm.2012.129
DO - 10.1038/jcbfm.2012.129
M3 - SCORING: Journal article
C2 - 23047272
VL - 33
SP - 76
EP - 84
JO - J CEREBR BLOOD F MET
JF - J CEREBR BLOOD F MET
SN - 0271-678X
IS - 1
M1 - 1
ER -
