Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion-Reference-Cited by-同舟云学术

Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion

Published:2021-07 Issue:7 Volume:52 Page:2338-2346
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Scheldeman Lauranne¹²³^ORCID,Wouters Anke¹²³^ORCID,Dupont Patrick⁴⁵^ORCID,Christensen Soren⁶,Boutitie Florent⁷⁸,Cheng Bastian⁹^ORCID,Ebinger Martin¹⁰¹¹,Endres Matthias¹⁰¹²¹³¹⁴¹⁵^ORCID,Fiebach Jochen B.¹⁰^ORCID,Gerloff Christian⁹,Muir Keith W.¹⁶^ORCID,Nighoghossian Norbert¹⁷^ORCID,Pedraza Salvador¹⁸^ORCID,Simonsen Claus Z.¹⁹^ORCID,Ringelstein Erich B.²⁰,Chamorro Angel²¹^ORCID,Grond Martin²²²³,Laage Rico²⁴,Schneider Armin²⁵,Thomalla Götz⁹^ORCID,Thijs Vincent²⁶²⁷^ORCID,Lemmens Robin¹²³^ORCID

Affiliation:

1. Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R. Lemmens).

2. Department of Neurosciences, Experimental Neurology (L.S., A.W., R. Lemmens), KU Leuven–University of Leuven, Belgium.

3. Center for Brain and Disease Research, Laboratory of Neurobiology, Vlaams Instituut voor Biotechnologie (VIB), Leuven, Belgium (L.S., A.W., R. Lemmens).

4. Department of Neurosciences, Laboratory for Cognitive Neurology (P.D.), KU Leuven–University of Leuven, Belgium.

5. Leuven Brain Institute, Belgium (P.D.).

6. GrayNumber Analytics, Lomma, Sweden (S.C.).

7. Hospices Civils de Lyon, Service de Biostatistique, France (F.B.).

8. Université Lyon 1, Villeurbanne, France (F.B.).

9. Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.).

10. Center for Stroke Research Berlin (M. Ebinger, M. Endres, J.B.F.), Charité–Universitätsmedizin Berlin, Germany.

11. Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Germany (M. Ebinger).

12. Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité–Universitätsmedizin Berlin, Germany.

13. German Center for Cardiovascular Research, Partner Site Berlin (M. Endres).

14. German Center for Neurodegenerative Diseases, Partner Site Berlin (M. Endres).

15. ExcellenceCluster “NeuroCure” (M. Endres).

16. Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom (K.W.M.).

17. Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, Hospices Civils de Lyon, France (N.N.).

18. Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d’Investigació Biomedica de Girona, Parc Hospitalari Marti i Julia de Salt–Edifici M2, Spain (S.P.).

19. Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.).

20. Department of Neurology, University of Münster, Germany (E.B.R.).

21. Stroke Centre, University of Barcelona, Spain (A.C.).

22. Kreisklinikum Siegen GmbH, Germany (M.G.).

23. University of Marburg, Germany (M.G.).

24. GUIDED Development Heidelberg GmbH, Germany (R. Laage).

25. Lifedatascience Consulting, Schriesheim, Germany (A.S.).

26. Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.).

27. Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.).

Abstract

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 mm 2 /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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.033071

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