Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment?

Meisterernst, Julia Anne; Klinger-Gratz, Pascal P; Leidolt, Lars; Lang, Matthias; Schroth, Gerhard; Mordasini, Pasquale; Heldner, Mirjam Rachel; Mono, Marie-Luise; Kurmann, Rebekka; Bühlmann, Monika; Fischer, Urs; Arnold, Marcel; Gralla, Jan; Mattle, Heinrich; El-Koussy, Marwan; Jung, Simon (2017). Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment? PLoS ONE, 12(9), e0185158. Public Library of Science 10.1371/journal.pone.0185158

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BACKGROUND AND PURPOSE Some authors use FLAIR imaging to select patients for stroke treatment. However, the effect of hyperintensity on FLAIR images on outcome and bleeding has been addressed in only few studies with conflicting results. METHODS 466 patients with anterior circulation strokes were included in this study. They all were examined with MRI before intravenous or endovascular treatment. Baseline data and 3 months outcome were recorded prospectively. Focal T2 and FLAIR hyperintensities within the ischemic lesion were evaluated by two raters, and the PROACT II classification was applied to assess bleeding complications on follow up imaging. Logistic regression analysis was used to determine predictors of bleeding complications and outcome and to analyze the influence of T2 or FLAIR hyperintensity on outcome. RESULTS Focal hyperintensities were found in 142 of 307 (46.3%) patients with T2 weighted imaging and in 89 of 159 (56%) patients with FLAIR imaging. Hyperintensity in the basal ganglia, especially in the lentiform nucleus, on T2 weighted imaging was the only independent predictor of any bleeding after reperfusion treatment (33.8% in patients with vs. 18.2% in those without; p = 0.003) and there was a non-significant trend for more bleedings in patients with FLAIR hyperintensity within the basal ganglia (p = 0.069). However, there was no association of hyperintensity on T2 weighted or FLAIR images and symptomatic bleeding or worse outcome. CONCLUSION Our results question the assumption that T2 or FLAIR hyperintensities within the ischemic lesion should be used to exclude patients from reperfusion therapy, especially not from endovascular treatment.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Meisterernst, Julia Anne; Leidolt, Lars; Lang, Matthias; Mordasini, Pasquale; Heldner, Mirjam Rachel; Mono, Marie-Luise; Kurmann, Rebekka; Bühlmann, Monika; Fischer, Urs; Arnold, Marcel; Gralla, Jan; Mattle, Heinrich; El-Koussy, Marwan and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

13 Oct 2017 10:47

Last Modified:

11 Dec 2017 14:46

Publisher DOI:

10.1371/journal.pone.0185158

PubMed ID:

28957339

BORIS DOI:

10.7892/boris.105778

URI:

https://boris.unibe.ch/id/eprint/105778

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