A Comparison of T2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study.

Background: T2 relaxation-based magnetic resonance imaging (MRI) signals may provide onset time for acute ischemic strokes with an unknown onset. The ability of visual and quantitative MRI-based methods in a cohort of hyperacute ischemic stroke patients was studied. Methods: A total of 35 patients u...

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Published in:Journal of Central Nervous System Disease pp. 1 - 14
Main Authors: McGarry, Bryony L, Damion, Robin A, Chew, Isabel, Knight, Michael J, Harston, George WJ, Carone, Davide, Jezzard, Peter, Sitaram, Amith, Muir, Keith W, Clatworthy, Philip, Kauppinen, Risto A
Format: diagnostic images equations & formulas research tables/charts Journal Article
Published: Sage Publications Inc. 9/12/2020
Online Access:View this record in EBSCOhost
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      dt: 9/12/2020
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      pub: Sage Publications Inc.
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        atl: A Comparison of T2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study.
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          McGarry, Bryony L
          Damion, Robin A
          Chew, Isabel
          Knight, Michael J
          Harston, George WJ
          Carone, Davide
          Jezzard, Peter
          Sitaram, Amith
          Muir, Keith W
          Clatworthy, Philip
          Kauppinen, Risto A
        affil: School of Psychological Science, University of Bristol, Bristol, UK
      sug:
        subj:
          Magnetic Resonance Imaging Methods
          Stroke Etiology
          Stroke Patients
          Human
          Pilot Studies
          ROC Curve
          Sensitivity and Specificity
          Thrombosis
          Signal Processing, Computer Assisted
          Image Processing, Computer Assisted
          Data Analysis Software
          Descriptive Statistics
          Aged
          Aged: 65+ years
      ab: Background: T2 relaxation-based magnetic resonance imaging (MRI) signals may provide onset time for acute ischemic strokes with an unknown onset. The ability of visual and quantitative MRI-based methods in a cohort of hyperacute ischemic stroke patients was studied. Methods: A total of 35 patients underwent 3T (3 Tesla) MRI (<9-hour symptom onset). Diffusion-weighted (DWI), apparent diffusion coefficient (ADC), T1-weighted (T1w), T2-weighted (T2w), and T2 relaxation time (T2) images were acquired. T2-weighted fluid attenuation inversion recovery (FLAIR) images were acquired for 17 of these patients. Image intensity ratios of the average intensities in ischemic and non-ischemic reference regions were calculated for ADC, DWI, T2w, T2 relaxation, and FLAIR images, and optimal image intensity ratio cut-offs were determined. DWI and FLAIR images were assessed visually for DWI/FLAIR mismatch. Results: The T2 relaxation time image intensity ratio was the only parameter with significant correlation with stroke duration (r = 0.49, P =.003), an area under the receiver operating characteristic curve (AUC = 0.77, P <.0001), and an optimal cut-off (T2 ratio = 1.072) that accurately identified patients within the 4.5-hour thrombolysis treatment window with sensitivity of 0.74 and specificity of 0.74. In the patients with the additional FLAIR, areas under the precision-recall-gain curve (AUPRG) and F1 scores showed that the T2 relaxation time ratio (AUPRG = 0.60, F1 = 0.73) performed considerably better than the FLAIR ratio (AUPRG = 0.39, F1 = 0.57) and the visual DWI/FLAIR mismatch (F1 = 0.25). Conclusions: Quantitative T2 relaxation time is the preferred MRI parameter in the assessment of patients with unknown onset for treatment stratification.
      pubtype: Academic Journal
      doctype:
        diagnostic images
        equations & formulas
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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