Lauranne Scheldeman, Pierre Seners, Anke Wouters, Patrick Dupont, Soren Christensen, Michael Mlynash, Caroline Arquizan, Adrien Ter Schiphorst, Vincent Costalat, Hilde Henon, Martin Bretzner, Jean-François Albucher, Christophe Cognard, Jean-Marc Olivot, Jeremy J Heit, Gregory W Albers, Maarten G Lansberg, Robin Lemmens
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However, the expected clinical recovery congruent with penumbral salvage is not always observed.</p><p><strong>Aims: </strong>We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.</p><p><strong>Methods: </strong>In the prospective French Acute Multimodal Imaging Study to Select Patients for Mechanical Thrombectomy (FRAME) and an observational cohort of patients with large vessel occlusions undergoing endovascular treatment, we quantified penumbral integrity by fluid-attenuated inversion recovery (FLAIR) changes. We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).</p><p><strong>Results: </strong>Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).</p><p><strong>Conclusions: </strong>Recanalization status did not influence the evolution of penumbral FLAIR changes. FLAIR SI changes in the baseline penumbra were associated with tissue fate, but not functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions.\",\"authors\":\"Lauranne Scheldeman, Pierre Seners, Anke Wouters, Patrick Dupont, Soren Christensen, Michael Mlynash, Caroline Arquizan, Adrien Ter Schiphorst, Vincent Costalat, Hilde Henon, Martin Bretzner, Jean-François Albucher, Christophe Cognard, Jean-Marc Olivot, Jeremy J Heit, Gregory W Albers, Maarten G Lansberg, Robin Lemmens\",\"doi\":\"10.1177/17474930241289235\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. 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We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).</p><p><strong>Results: </strong>Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).</p><p><strong>Conclusions: </strong>Recanalization status did not influence the evolution of penumbral FLAIR changes. 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引用次数: 0
摘要
背景:急性缺血性脑卒中患者的半影被定义为再灌注时仍可挽救的缺血组织。目的:我们旨在确定磁共振成像(MRI)定义的半影是否包括阻碍再灌注后预期临床恢复的不可逆神经元损失:在前瞻性的法国急性多模态成像研究(FRAME)和接受血管内治疗的大血管闭塞患者观察队列中,我们通过FLAIR变化量化了半影的完整性。我们研究了再通畅状态对半影FLAIR变化演变的影响,并研究了半影FLAIR变化作为组织命运和90天改良Rankin量表(mRS)功能结果的预测因子:再通畅状态并不改变rFLAIR信号强度(SI)随时间的变化,但在FRAME亚组中与较低的SI相关(b=-0.06,交互作用p=0.04)。随后梗死的半影中位rFLAIR SI基线高于挽救的半影(比值=1.07,标准差[SD] 0.07 vs 1.03,SD 0.06):再通畅状态并不影响半影 FLAIR 变化的演变。基线半影的FLAIR SI变化与组织命运有关,但与功能结果无关:支持本研究的数据可在合理要求下提供,但需签署数据访问协议。
Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions.
Background: In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.
Aims: We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.
Methods: In the prospective French Acute Multimodal Imaging Study to Select Patients for Mechanical Thrombectomy (FRAME) and an observational cohort of patients with large vessel occlusions undergoing endovascular treatment, we quantified penumbral integrity by fluid-attenuated inversion recovery (FLAIR) changes. We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).
Results: Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).
Conclusions: Recanalization status did not influence the evolution of penumbral FLAIR changes. FLAIR SI changes in the baseline penumbra were associated with tissue fate, but not functional outcome.
期刊介绍:
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.