Final Cerebral Infarct Volume Is Predictable by MR Imaging at 1 Week

Tourdias, Thomas; Renou, Pauline; Sibon, Igor; Asselineau, Julien; Bracoud, Luc; Dumoulin, M; Rouanet, François; Orgogozo, J. M.; Dousset, V.

doi:10.3174/ajnr.a2271

Cited by 37 publications

(26 citation statements)

References 36 publications

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“…Several studies have shown that a FLAIR sequence performed at 3 to 5 days may be the most accurate early indicator of true infarct volume. 24 However, the timing of this imaging sequence may result in loss to follow-up as some patients may not be available to undergo the study because of either death or early discharge. In addition, at that point in time, the FLAIR sequence incorporates a certain element of edema that may result in overrepresentation of the final infarct lesion.…”

Section: December 2012mentioning

confidence: 99%

Final Infarct Volume Is a Stronger Predictor of Outcome Than Recanalization in Patients With Proximal Middle Cerebral Artery Occlusion Treated With Endovascular Therapy

Zaidi

Aghaebrahim

Urra³

et al. 2012

Stroke

184

134

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This study represents a retrospective analysis of a prospectively acquired database comprising 562 consecutive patients with acuteBackground and Purpose-The rationale for recanalization therapy in acute ischemic stroke is to preserve brain through penumbral salvage and thus improve clinical outcomes. We sought to determine the relationship between recanalization, clinical outcomes, and final infarct volumes in acute ischemic stroke patients presenting with middle cerebral artery occlusion who underwent endovascular therapy and post-procedure magnetic resonance imaging.Methods-We identified 201 patients with middle cerebral artery occlusion. Patients with other occlusive lesions were excluded. Baseline clinical/radiological characteristics, procedural outcomes (including thrombolysis in cerebral infarction scores), clinical outcome scores (modified Rankin scores), and final infarct volumes on diffusion weighted imaging were retrospectively analyzed from a prospectively collected database. Favorable outcome is defined as 90-day modified Rankin score ≤2. Results-Successful recanalization (thrombolysis in cerebral infarction grade 2b or 3) was achieved in 63.2% and favorable outcomes in 46% of cases. Mean infarct volume was 50.1 mL in recanalized versus 133.9 mL in non-recanalized patients (P<0.01) and 40.4 mL in patients with favorable outcomes versus 111.8 in patients with unfavorable outcomes (P<0.01).In multivariate analysis, thrombolysis in cerebral infarction ≥2b, baseline National Institute of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography scores, and age were identified as independent predictors of outcome. However, when infarct volumes were included in the analysis only final infarct volume and age remained significantly associated. Conclusions-Successful recanalization leads to improved functional outcomes through a reduction in final infarct volumes. In our series, age and final infarct volume but not recanalization were found to be independent predictors of outcome, supporting the use of final infarct volume as surrogate marker of outcome in acute stroke trials. (Stroke. 2012;43:3238-3244.)Key Words: acute stroke ◼ infarct volume ◼ interventional treatment ◼ stroke outcome

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Section: December 2012mentioning

confidence: 99%

Final Infarct Volume Is a Stronger Predictor of Outcome Than Recanalization in Patients With Proximal Middle Cerebral Artery Occlusion Treated With Endovascular Therapy

Zaidi

Aghaebrahim

Urra³

et al. 2012

Stroke

184

134

View full text Add to dashboard Cite

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“…Postoperative metabolic and immunologic changes are proportional to the degree of surgical trauma and subsequent changes may be implicated in the development of septic complications and tumor metastasis formation [9,10,11,12]. There are currently various data showing that laparoscopy results in a reduction of the inflammatory response and preservation of the patients’ immune functions [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Immunological Consequences of Laparoscopic versus Open Transhiatal Resection for Malignancies of the Distal Esophagus and Gastroesophageal Junction

et al. 2008

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Background/Aim: Surgery remains the only curative therapy for esophageal cancer. The objective of the current study was to evaluate the impact of laparoscopic transhiatal esophagectomy versus open transhiatal esophagectomy on both inflammatory and immunological responses. Methods: Seventeen patients undergoing laparoscopic or open surgery were included in the study. The postoperative inflammatory response was assessed by measuring WBC count and CRP, IL-6, IL-8, soluble TNF I and II receptor, and elastase levels. The postoperative immune function was assessed by measuring the monocyte HLA-DR expression. LPS-binding protein (LBP) and bactericidal/permeability-increasing protein (BPI) were measured to evaluate bacterial translocation. Results: The IL-6 level increased significantly more in the patients who received open surgery as compared with the laparoscopic group. Both LBP and BPI increased predominantly in the laparoscopic group as compared with the group who received open surgery. No difference was found in HLA-DR expression between the two groups. Conclusion: Although both laparoscopic and conventional esophageal resections result in an activation of the inflammatory response, this study suggests that this response could be less pronounced after the laparoscopic approach. However, in the laparoscopic group higher LBP and BPI levels were seen, suggesting an increased endotoxemia. We postulate that the persistently elevated abdominal pressure results in a loss of mucosal barrier function, resulting in bacterial translocation. The cellular acidification of the cells of the peritoneum induced by CO₂ insufflation, however, blunts the expected inflammatory response.

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“…7,13,14 In addition, infarct volume on FLAIR images is found to decrease over time within 1 month, but disappearance of infarcts on FLAIR has, to the best of our knowledge, never been reported. 15 These results suggest that the absence of a relationship between a high-risk plaque with IPH or TRFC components and the presence of infarcts on FLAIR images could not be explained by the rather long time interval between index event and imaging (median, 45 days; range, 7-100 days). Nevertheless, because FLAIR images also show infarcts older than the index event, this might explain why in the current study the presence of IPH and TRFC does not correlate with cerebral infarcts on MRI, in contrast to previously published studies on diffusion-weighted imaging positive infarcts in an early phase after the ischemic symptoms.…”

Section: Discussionmentioning

confidence: 69%

Plaque Components in Symptomatic Moderately Stenosed Carotid Arteries Related to Cerebral Infarcts

Rotte

Truijman

Dijk

et al. 2015

Stroke

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Background and Purpose-Carotid plaque composition is a major determinant of cerebrovascular events. In the present analysis, we evaluated the relationship between intraplaque hemorrhage (IPH) and a thin/ruptured fibrous cap (TRFC) in moderately stenosed carotid arteries and cerebral infarcts on MRI in the ipsilateral hemisphere. Methods-A total of 101 patients with a symptomatic 30% to 69% carotid artery stenosis underwent MRI of the carotid arteries and the brain, within a median time of 45 days from onset of symptoms. The presence of ipsilateral infarcts in patients with and without IPH and TRFC was evaluated. Results-IPH was seen in 40 of 101 plaques. TRFC was seen in 49 of 86 plaques (postcontrast series were not obtained in 15 patients). In total, 51 infarcts in the flow territory of the symptomatic carotid artery were found in 47 patients. Twenty nine of these infarcts, found in 24 patients, were cortical infarcts. No significant relationship was found between IPH or TRFC and the presence of ipsilateral infarcts. Conclusions-MRI ImagingBrain and carotid imaging were performed on the same day. Imaging was performed on 3.0 Tesla whole-body MRI scanners, with an imaging protocol described previously.8 A brief description of the imaging protocol can be found on http://stroke.ahajournals.org. Image AnalysisTwo trained readers (M.T. and A.D.), blinded for the brain MRI results, performed the carotid MRI analysis in VesselMASS (Leiden University Medical Center, Leiden, the Netherlands). Analysis was performed according to previously published criteria, which demonstrated a moderate to good intra-and interobserver reproducibility (κ coefficient=0.60-1.00). 9 All brain MRI scans were evaluated for the presence of infarcts. Of all scored infarcts, the localization in the brain (cortical or subcortical) and the flow territory was subsequently determined. Brain images were assessed by a single experienced neuroradiologist (J.H.), blinded for the carotid MRI and clinical characteristics. Statistical AnalysisThe association between plaque components and the presence of infarcts on MRI was evaluated with a Fisher exact test. Statistical analyses were performed in IBM SPSS Statistics version 20 (IBM Corporation, Armonk, NY). ResultsIPH was present in 40 of 101 patients. In 15 patients, the fibrous cap status could not be assessed because no postcontrast MRI was obtained (n=6) or the postcontrast series had inferior image quality (n=9). Consequently, the fibrous cap status could be evaluated in 86 patients, and a TRFC was present in 49 of these patients. In 8 patients, both a TRFC and IPH were present (Figure 1). In total, 51 infarcts in the flow territory of the symptomatic carotid artery were found in 47 patients. Twenty nine of these infarcts, found in 24 patients, were located in the cortical region (Figure 2). An overview of baseline characteristics is given in the Table. In Table I in the online-only Data Supplement, a distribution of infarcts compared with the classification of the index event is demonstrated. Fe...

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Final Cerebral Infarct Volume Is Predictable by MR Imaging at 1 Week

Cited by 37 publications

References 36 publications

Final Infarct Volume Is a Stronger Predictor of Outcome Than Recanalization in Patients With Proximal Middle Cerebral Artery Occlusion Treated With Endovascular Therapy

Final Infarct Volume Is a Stronger Predictor of Outcome Than Recanalization in Patients With Proximal Middle Cerebral Artery Occlusion Treated With Endovascular Therapy

Immunological Consequences of Laparoscopic versus Open Transhiatal Resection for Malignancies of the Distal Esophagus and Gastroesophageal Junction

Plaque Components in Symptomatic Moderately Stenosed Carotid Arteries Related to Cerebral Infarcts

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