BACKGROUND: Reliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI). METHODS: Acute stroke patients, enrolled between 2013 and 2014 with serial magnetic resonance imaging (MRI) scans (pretreatment baseline, 2 h post, and 24 h post), who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 h on diffusion, and percent of early reperfusion were calculated from the baseline and 2 h MRI scans were compared. ENI was defined as ≥4 point decrease in National Institutes of Health Stroke Scales within 24 h. Logistic regression models and receiver operator characteristics analysis were used to compare the efficacy of 3 imaging biomarkers. RESULTS: Serial MRIs of 58 acute stroke patients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (OR 0.93, p = 0.048) and remained significant after controlling for stroke size and severity (OR 0.90, p = 0.032). Thus, for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 h nor percent of early reperfusion were significantly associated with ENI by logistic regression. Receiver-operator characteristic analysis identified early change in stroke volume as the only biomarker of the 3 that performed significantly different than chance (p = 0.03). CONCLUSIONS: Early fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the more traditional measures of final infarct volume and percent of early reperfusion.
BACKGROUND: Reliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI). METHODS:Acute strokepatients, enrolled between 2013 and 2014 with serial magnetic resonance imaging (MRI) scans (pretreatment baseline, 2 h post, and 24 h post), who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 h on diffusion, and percent of early reperfusion were calculated from the baseline and 2 h MRI scans were compared. ENI was defined as ≥4 point decrease in National Institutes of Health Stroke Scales within 24 h. Logistic regression models and receiver operator characteristics analysis were used to compare the efficacy of 3 imaging biomarkers. RESULTS: Serial MRIs of 58 acute strokepatients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (OR 0.93, p = 0.048) and remained significant after controlling for stroke size and severity (OR 0.90, p = 0.032). Thus, for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 h nor percent of early reperfusion were significantly associated with ENI by logistic regression. Receiver-operator characteristic analysis identified early change in stroke volume as the only biomarker of the 3 that performed significantly different than chance (p = 0.03). CONCLUSIONS: Early fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the more traditional measures of final infarct volume and percent of early reperfusion.
Authors: Bruce C V Campbell; Archana Purushotham; Soren Christensen; Patricia M Desmond; Yoshinari Nagakane; Mark W Parsons; Maarten G Lansberg; Michael Mlynash; Matus Straka; Deidre A De Silva; Jean-Marc Olivot; Roland Bammer; Gregory W Albers; Geoffrey A Donnan; Stephen M Davis Journal: J Cereb Blood Flow Metab Date: 2011-07-20 Impact factor: 6.200
Authors: Shreyansh Shah; Marie Luby; Karen Poole; Teresa Morella; Elizabeth Keller; Richard T Benson; John K Lynch; Zurab Nadareishvili; Amie W Hsia Journal: Neurology Date: 2015-05-13 Impact factor: 9.910
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Kenichi Oishi; Andreia Faria; Hangyi Jiang; Xin Li; Kazi Akhter; Jiangyang Zhang; John T Hsu; Michael I Miller; Peter C M van Zijl; Marilyn Albert; Constantine G Lyketsos; Roger Woods; Arthur W Toga; G Bruce Pike; Pedro Rosa-Neto; Alan Evans; John Mazziotta; Susumu Mori Journal: Neuroimage Date: 2009-06 Impact factor: 6.556
Authors: Jens Fiehler; Karina Knudsen; Thomas Kucinski; Chelsea S Kidwell; Jeffry R Alger; Götz Thomalla; Bernd Eckert; Oliver Wittkugel; Cornelius Weiller; Hermann Zeumer; Joachim Röther Journal: Stroke Date: 2004-01-22 Impact factor: 7.914
Authors: Chelsea S Kidwell; Jeffrey L Saver; Sidney Starkman; Gary Duckwiler; Reza Jahan; Paul Vespa; J Pablo Villablanca; David S Liebeskind; Y Pierre Gobin; Fernando Vinuela; Jeffry R Alger Journal: Ann Neurol Date: 2002-12 Impact factor: 10.422
Authors: Alexis N Simpkins; Katharina M Busl; Edilberto Amorim; Carolina Barnett-Tapia; Mackenzie C Cervenka; Monica B Dhakar; Mark R Etherton; Celia Fung; Robert Griggs; Robert G Holloway; Adam G Kelly; Imad R Khan; Karlo J Lizarraga; Hannah G Madagan; Chidinma L Onweni; Humberto Mestre; Alejandro A Rabinstein; Clio Rubinos; Dawling A Dionisio-Santos; Teddy S Youn; Lisa H Merck; Carolina B Maciel Journal: Neurocrit Care Date: 2020-09-21 Impact factor: 3.210
Authors: Nam Hun Heo; Man Ryul Lee; Ki Hwa Yang; Ock Ran Hong; Ji Hyeon Shin; Bo Yeon Lee; Ji Young Lee; Jae Min Ahn; Hyuk Jin Oh; Jae Sang Oh Journal: Medicine (Baltimore) Date: 2021-11-05 Impact factor: 1.817