Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset

Bastian Cheng, Mathias Brinkmann, Nils D. Forkert, Andras Treszl, Martin Ebinger, Martin Köhrmann, Ona Wu, Dong Wha Kang, David S. Liebeskind, Thomas Tourdias, Oliver C. Singer, Soren Christensen, Marie Luby, Steven Warach, Jens Fiehler, Jochen B. Fiebach, Christian Gerloff, Götz Thomalla

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)76-84
Number of pages9
JournalJournal of Cerebral Blood Flow and Metabolism
Volume33
Issue number1
DOIs
StatePublished - Jan 2013

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Stroke
Stroke Volume
Magnetic Resonance Imaging
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Keywords

  • acute stroke
  • diffusion-weighted imaging
  • fluid-attenuated inversion recovery
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Neurology

Cite this

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.

In: Journal of Cerebral Blood Flow and Metabolism, Vol. 33, No. 1, 01.2013, p. 76-84.

Research output: Contribution to journalArticle

Cheng, B, Brinkmann, M, Forkert, ND, Treszl, A, Ebinger, M, Köhrmann, M, Wu, O, Kang, DW, Liebeskind, DS, Tourdias, T, Singer, OC, Christensen, S, Luby, M, Warach, S, Fiehler, J, Fiebach, JB, Gerloff, C & Thomalla, G 2013, 'Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset', Journal of Cerebral Blood Flow and Metabolism, vol. 33, no. 1, pp. 76-84. https://doi.org/10.1038/jcbfm.2012.129
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. / Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR) signal intensities in acute stroke for the prediction of time from symptom onset. In: Journal of Cerebral Blood Flow and Metabolism. 2013 ; Vol. 33, No. 1. pp. 76-84.
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abstract = "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.",
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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

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AU - Gerloff, Christian

AU - Thomalla, Götz

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