M Ernst1, A M M Boers2,3,4, N D Forkert5, O A Berkhemer2,6,7, Y B Roos8, D W J Dippel6, A van der Lugt9, R J van Oostenbrugge10, W H van Zwam11, E Vettorazzi12, J Fiehler13, H A Marquering2,3, C B L M Majoie2, S Gellissen13. 1. From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.) m.ernst@uke.de. 2. Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.). 3. Biomedical Engineering and Physics (A.M.M.B., H.A.M.). 4. Department of Robotics and Mechatronics (A.M.M.B.), University of Twente, Enschede, the Netherlands. 5. Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada. 6. Departments of Neurology (O.A.B., D.W.J.D.). 7. Department of Radiology (O.A.B.), Maastricht University Medical Center, Maastricht, the Netherlands. 8. Neurology (Y.B.R.), Academic Medical Center, Amsterdam, the Netherlands. 9. Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands. 10. Department of Neurology (R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute, Maastricht, the Netherlands. 11. Department of Radiology and Cardiovascular Research Institute Maastricht (W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands. 12. Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 13. From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.).
Abstract
BACKGROUND AND PURPOSE: Previous studies indicated that ischemic lesion volume might be a useful surrogate marker for functional outcome in ischemic stroke but should be considered in the context of lesion location. In contrast to previous studies using the ROI approach, which has several drawbacks, the present study aimed to measure the impact of ischemic lesion location on functional outcome using a more precise voxelwise approach. MATERIALS AND METHODS: Datasets of patients with acute ischemic strokes from the Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) were used. Primary outcome was functional outcome as assessed by the modified Rankin Scale 3 months after stroke. Ischemic lesion volume was determined on CT scans 3-9 days after stroke. Voxel-based lesion-symptom mapping techniques, including covariates that are known to be associated with functional outcome, were used to determine the impact of ischemic lesion location for outcome. RESULTS: Of the 500 patients in the MR CLEAN trial, 216 were included for analysis. The mean age was 63 years. Lesion-symptom mapping with inclusion of covariates revealed that especially left-hemispheric lesions in the deep periventricular white matter and adjacent internal capsule showed a great influence on functional outcome. CONCLUSIONS: Our study confirms that infarct location has an important impact on functional outcome of patients with stroke and should be considered in prediction models. After we adjusted for covariates, the left-hemispheric corticosubcortical fiber tracts seemed to be of higher functional importance compared with cortical lesions.
RCT Entities:
BACKGROUND AND PURPOSE: Previous studies indicated that ischemic lesion volume might be a useful surrogate marker for functional outcome in ischemic stroke but should be considered in the context of lesion location. In contrast to previous studies using the ROI approach, which has several drawbacks, the present study aimed to measure the impact of ischemic lesion location on functional outcome using a more precise voxelwise approach. MATERIALS AND METHODS: Datasets of patients with acute ischemic strokes from the Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) were used. Primary outcome was functional outcome as assessed by the modified Rankin Scale 3 months after stroke. Ischemic lesion volume was determined on CT scans 3-9 days after stroke. Voxel-based lesion-symptom mapping techniques, including covariates that are known to be associated with functional outcome, were used to determine the impact of ischemic lesion location for outcome. RESULTS: Of the 500 patients in the MR CLEAN trial, 216 were included for analysis. The mean age was 63 years. Lesion-symptom mapping with inclusion of covariates revealed that especially left-hemispheric lesions in the deep periventricular white matter and adjacent internal capsule showed a great influence on functional outcome. CONCLUSIONS: Our study confirms that infarct location has an important impact on functional outcome of patients with stroke and should be considered in prediction models. After we adjusted for covariates, the left-hemispheric corticosubcortical fiber tracts seemed to be of higher functional importance compared with cortical lesions.
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