Document Detail

Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less.
MedLine Citation:
PMID:  19557859     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the use of fluid-attenuated inversion recovery (FLAIR) imaging as surrogate marker of lesion age within the first 6 hours of ischemic stroke. METHODS: e analyzed FLAIR and diffusion-weighted imaging (DWI) sequences performed within 6 hours of symptom onset in 120 consecutive patients with ischemic stroke with known symptom onset. The visibility of acute ischemic lesions on FLAIR images was judged in two steps (on FLAIR alone and with knowledge of DWI) and compared with DWI. RESULTS: egative FLAIR in the case of positive DWI allocated ischemic lesions to a time window 3 hours or less with a high specificity (0.93) and a high positive predictive value (0.94), whereas sensitivity (0.48) and negative predictive value (0.43) were low. Lesion visibility on FLAIR images alone (35.6%) and with knowledge of DWI (62.5%) was lower than on DWI (97.1%). The sensitivity of FLAIR increased with increasing time from symptom onset from 27.0/50.0% <or= 3 hours to 56.7/93.3% after 3 to 6 hours (FLAIR alone/with knowledge of DWI). Multivariate regression analysis spotted longer time from symptom onset and larger size of the ischemic lesion as independent predictors of lesion visibility on FLAIR images. INTERPRETATION: "mismatch" between positive DWI and negative FLAIR allows the identification of patients that are highly likely to be within the 3-hour time window. Within the first 6 hours of stroke, the sensitivity of FLAIR sequences for acute ischemic lesions increases with time from symptom onset elapsing, approximating 100% after 3 to 6 hours.
Götz Thomalla; Philipp Rossbach; Michael Rosenkranz; Susanne Siemonsen; Anna Krützelmann; Jens Fiehler; Christian Gerloff
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Annals of neurology     Volume:  65     ISSN:  1531-8249     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-07-29     Completed Date:  2009-08-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  724-32     Citation Subset:  IM    
Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg, Eppendorf, Hamburg, Germany.
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MeSH Terms
Body Fluids*
Brain Ischemia / complications,  diagnosis*,  therapy
Diffusion Magnetic Resonance Imaging / methods*
Follow-Up Studies
Middle Aged
Prospective Studies
Retrospective Studies
Stroke / complications,  diagnosis*,  therapy
Time Factors

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