BACKGROUND: Previous studies identified a high frequency of silent ischemic lesion recurrence on magnetic resonance imaging (MRI) after an index stroke. OBJECTIVE: To investigate whether ischemic lesion recurrence on MRI predicts subsequent clinical events. DESIGN: Retrospective cohort study. SETTING: General community hospital. Patients We recruited 120 patients who experienced an acute ischemic stroke (IS) and who underwent initial MRI within 24 hours of onset and subsequent MRI on day 5. Of those patients, 68 underwent follow-up MRI up to 90 days after onset. MAIN OUTCOME MEASURES: Early silent lesion recurrence was defined as new asymptomatic ischemic lesions on 5-day MRI, and late silent lesion recurrence was defined as those on 30- or 90-day MRI. Patients were followed up for recurrent vascular events by interviews. RESULTS: Among the 104 patients (86.7%) who had available clinical outcome data, 35 (33.7%) had early silent lesion recurrence; 15 (22.1%) of 68 patients had late silent lesion recurrence. Of the patients, 8 experienced a recurrent IS, 3 experienced a transient ischemic attack, and 3 had vascular deaths during a mean +/- SD follow-up of 19.3 +/- 9.0 months. For recurrent IS as a clinical end point, late silent lesion recurrence independently predicted recurrent IS (odds ratio, 6.55; 95% confidence interval, 1.09-39.55) by the Cox proportional hazards model. For combined clinical end points, early (odds ratio, 3.19; 95% confidence interval, 1.02-10.00) and late (odds ratio, 8.09; 95% confidence interval, 1.29-50.91) silent lesion recurrences independently predicted clinical recurrent IS, transient ischemic attack, or vascular deaths. CONCLUSION: These data suggest that silent ischemic lesion recurrence on MRI may be a potential surrogate marker of clinical recurrence.
BACKGROUND: Previous studies identified a high frequency of silent ischemic lesion recurrence on magnetic resonance imaging (MRI) after an index stroke. OBJECTIVE: To investigate whether ischemic lesion recurrence on MRI predicts subsequent clinical events. DESIGN: Retrospective cohort study. SETTING: General community hospital. Patients We recruited 120 patients who experienced an acute ischemic stroke (IS) and who underwent initial MRI within 24 hours of onset and subsequent MRI on day 5. Of those patients, 68 underwent follow-up MRI up to 90 days after onset. MAIN OUTCOME MEASURES: Early silent lesion recurrence was defined as new asymptomatic ischemic lesions on 5-day MRI, and late silent lesion recurrence was defined as those on 30- or 90-day MRI. Patients were followed up for recurrent vascular events by interviews. RESULTS: Among the 104 patients (86.7%) who had available clinical outcome data, 35 (33.7%) had early silent lesion recurrence; 15 (22.1%) of 68 patients had late silent lesion recurrence. Of the patients, 8 experienced a recurrent IS, 3 experienced a transient ischemic attack, and 3 had vascular deaths during a mean +/- SD follow-up of 19.3 +/- 9.0 months. For recurrent IS as a clinical end point, late silent lesion recurrence independently predicted recurrent IS (odds ratio, 6.55; 95% confidence interval, 1.09-39.55) by the Cox proportional hazards model. For combined clinical end points, early (odds ratio, 3.19; 95% confidence interval, 1.02-10.00) and late (odds ratio, 8.09; 95% confidence interval, 1.29-50.91) silent lesion recurrences independently predicted clinical recurrent IS, transient ischemic attack, or vascular deaths. CONCLUSION: These data suggest that silent ischemic lesion recurrence on MRI may be a potential surrogate marker of clinical recurrence.
Authors: Eitan Auriel; M Brandon Westover; Matt T Bianchi; Yael Reijmer; Sergi Martinez-Ramirez; Jun Ni; Ellis Van Etten; Matthew P Frosch; Panagiotis Fotiadis; Kris Schwab; Anastasia Vashkevich; Grégoire Boulouis; Alayna P Younger; Keith A Johnson; Reisa A Sperling; Trey Hedden; M Edip Gurol; Anand Viswanathan; Steven M Greenberg Journal: Stroke Date: 2015-07-09 Impact factor: 7.914
Authors: Ralph Weber; Christian Weimar; Isabel Wanke; Claudia Möller-Hartmann; Elke R Gizewski; Jon Blatchford; Karin Hermansson; Andrew M Demchuk; Michael Forsting; Ralph L Sacco; Jeffrey L Saver; Steven Warach; Hans Christoph Diener; Anke Diehl Journal: Stroke Date: 2012-01-19 Impact factor: 7.914
Authors: N Gaillard; C Schmidt; V Costalat; J P Bousquet; C Heroum; D Milhaud; A Bonafe; C Arquizan Journal: AJNR Am J Neuroradiol Date: 2011-11-24 Impact factor: 3.825