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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 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.
GRAPHIC ABSTRACT: An online graphic abstract is available for this article.
https://www.hal.inserm.fr/inserm-03452102 Contributor : laboratoire CarMeNConnect in order to contact the contributor Submitted on : Friday, November 26, 2021 - 5:35:31 PM Last modification on : Friday, April 1, 2022 - 3:53:16 AM Long-term archiving on: : Sunday, February 27, 2022 - 8:05:54 PM
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L. Scheldeman, A. Wouters, P. Dupont, S. Christensen, F. Boutitie, et al.. Reversible Edema in the Penumbra Correlates With Severity of Hypoperfusion. Stroke, American Heart Association, 2021, 52 (7), pp.2338-2346. ⟨10.1161/strokeaha.120.033071⟩. ⟨inserm-03452102⟩