BACKGROUND: Based on previous observations of a high rate of ischemic lesion recurrence on diffusion-weighted imaging (DWI) within 1 week after an acute ischemic stroke, the authors hypothesized that silent new ischemic lesions are common between 1 week and 90 days after index stroke and that early lesion recurrence may be associated with late lesion recurrence. METHODS: The authors studied 80 acute ischemic stroke patients who had initial MRI performed within 48 hours, and follow-up scans at 5 days and at 30 or 90 days after onset. Early lesion recurrences were defined as new ischemic lesions on 5-day DWI, and late lesion recurrences were defined as those on 30- or 90-day DWI or fluid attenuation inversion recovery image. Early lesion recurrence occurring outside the initial perfusion deficit was termed distant lesion recurrence. RESULTS: Late lesion recurrence occurred in 26%, more frequently observed on 30-day MRI than 90-day MRI (p = 0.016). Early lesion recurrence (OR 4.0; 95% CI 1.3 to 11.7) and distant early lesion recurrence (OR 6.9; 95% CI 1.5 to 32.2) were independently associated with late lesion recurrence by multiple logistic regression analyses. CONCLUSIONS: There may be a continued risk for recurrent ischemic lesions in the weeks following the clinically symptomatic stroke. Future studies are needed to investigate whether MRI-defined ischemic lesion recurrences predict subsequent clinical recurrence and thus may be a potential surrogate endpoint in stroke secondary prevention trials.
BACKGROUND: Based on previous observations of a high rate of ischemic lesion recurrence on diffusion-weighted imaging (DWI) within 1 week after an acute ischemic stroke, the authors hypothesized that silent new ischemic lesions are common between 1 week and 90 days after index stroke and that early lesion recurrence may be associated with late lesion recurrence. METHODS: The authors studied 80 acute ischemic strokepatients who had initial MRI performed within 48 hours, and follow-up scans at 5 days and at 30 or 90 days after onset. Early lesion recurrences were defined as new ischemic lesions on 5-day DWI, and late lesion recurrences were defined as those on 30- or 90-day DWI or fluid attenuation inversion recovery image. Early lesion recurrence occurring outside the initial perfusion deficit was termed distant lesion recurrence. RESULTS: Late lesion recurrence occurred in 26%, more frequently observed on 30-day MRI than 90-day MRI (p = 0.016). Early lesion recurrence (OR 4.0; 95% CI 1.3 to 11.7) and distant early lesion recurrence (OR 6.9; 95% CI 1.5 to 32.2) were independently associated with late lesion recurrence by multiple logistic regression analyses. CONCLUSIONS: There may be a continued risk for recurrent ischemic lesions in the weeks following the clinically symptomatic stroke. Future studies are needed to investigate whether MRI-defined ischemic lesion recurrences predict subsequent clinical recurrence and thus may be a potential surrogate endpoint in stroke secondary prevention trials.
Authors: Jaume Roquer; A Rodríguez-Campello; E Cuadrado-Godia; R M Vivanco-Hidalgo; J Jiménez-Conde; X Perich; A Ois Journal: J Neurol Date: 2010-01-03 Impact factor: 4.849
Authors: Irene Klærke Mikkelsen; P Simon Jones; Lars Riisgaard Ribe; Josef Alawneh; Josep Puig; Susanne Lise Bekke; Anna Tietze; Jonathan H Gillard; Elisabeth A Warburton; Salva Pedraza; Jean-Claude Baron; Leif Østergaard; Kim Mouridsen Journal: Eur Radiol Date: 2015-04-17 Impact factor: 5.315
Authors: Una Clancy; Daniela Jaime Garcia; Michael S Stringer; Michael J Thrippleton; Maria C Valdés-Hernández; Stewart Wiseman; Olivia Kl Hamilton; Francesca M Chappell; Rosalind Brown; Gordon W Blair; Will Hewins; Emilie Sleight; Lucia Ballerini; Mark E Bastin; Susana Munoz Maniega; Tom MacGillivray; Kirstie Hetherington; Charlene Hamid; Carmen Arteaga; Alasdair G Morgan; Cameron Manning; Ellen Backhouse; Iona Hamilton; Dominic Job; Ian Marshall; Fergus N Doubal; Joanna M Wardlaw Journal: Eur Stroke J Date: 2020-06-05