Intralesional Patterns of MRI ADC Maps Predict Outcome in Experimental Stroke

Henriques, Isabel Lestro; Gutiérrez-Fernández, María; Rodríguez-Frutos, Berta; Ramos‐Cejudo, Jaime; Otero-Ortega, Laura; Hernanz, Teresa Navarro; Cerdán, Sebastián; Ferro, José M.; Díez‐Tejedor, Exuperio

doi:10.1159/000381727

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…In a rodent model for ischemic stroke, different ADC patterns were related to different functional outcomes in lesions of similar size after permanent MCA occlusion [25]. For clinical patients, DWI lesion pattern analysis is also considered a simple and reasonable method to predict patient outcome [13].…”

Section: Discussionmentioning

confidence: 99%

DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

et al. 2015

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Background: Lesion patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory; yet it remains unclear whether such imaging prognostic factors are related to patient outcome after intravenous thrombolysis. Aims: The aim of this study is to investigate the clinical outcome after intravenous thrombolysis in acute MCA ischemic strokes with respect to diffusion-weighted imaging (DWI) lesion patterns. Methods: Consecutive acute ischemic stroke cases of the MCA territory treated over a 7-year period were retrospectively analyzed. All acute MCA stroke patients underwent a MRI scan before intravenous thrombolytic therapy was included. DWI lesions were divided into 6 patterns (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts). Lesion volumes were measured by dedicated imaging processing software. Favorable outcome was defined as modified Rankin scale (mRS) of 0-2 at 90 days. Results: Among the 172 patients included in our study, 75 (43.6%) were observed to have territorial infarct patterns or other deep infarct patterns. These patients also had higher baseline NIHSS score (p < 0.001), a higher proportion of large cerebral artery occlusions (p < 0.001) and larger infarct volume (p < 0.001). Favorable outcome (mRS 0-2) was achieved in 89 patients (51.7%). After multivariable analysis, groups with specific lesion patterns, including territorial infarct and other deep infarct pattern, were independently associated with favorable outcome (OR 0.40; 95% CI 0.16-0.99; p = 0.047). Conclusions: Specific lesion patterns predict differential outcome after intravenous thrombolysis therapy in acute MCA stroke patients.

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Section: Discussionmentioning

confidence: 99%

DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

et al. 2015

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“…Some experimental studies show that a change in the reduction of lesion volume is not important to determining the severity of a cerebral infarct. In fact, infarct volume did not correlate with functional recovery when the neurovascular unit was integrated 24 . In our study, no reduction in the lesion size was observed on T2 images in animals treated with anti-NogoA immunotherapy compared with the control group at 24 h or 28 d. However, these results are consistent with previous studies that showed that this treatment did not reduce lesion size in an experimental animal model of cortical stroke 9 , 17 , 18 , 25 .…”

Section: Discussionmentioning

confidence: 88%

NogoA Neutralization Promotes Axonal Restoration After White Matter Injury In Subcortical Stroke

Otero-Ortega

Frutos

Laso-García

et al. 2017

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Blocking axonal growth inhibitor NogoA has been of great interest for promoting axonal recovery from neurological diseases. The present study investigates the therapeutic effects of blocking NogoA, inducing functional recovery and promoting white matter repair in an experimental animal model of stroke. Adult male rats were subjected to white matter injury by subcortical ischemic stroke. Twenty-four hours after surgery, 250 ug of anti-NogoA or anti-IgG-1 were administered through the tail vein. The quantity of NogoA protein was determined by immunohistochemistry in the brain and peripheral organs. In addition, functional status, lesion size, fiber tract integrity, axonal sprouting and white matter repair markers were analyzed. Moreover, an in vitro study was performed in order to strengthen the results obtained in vivo. A lower quantity of NogoA protein was found in the brain and peripheral organs of the animals that received anti-NogoA treatment. The animals receiving anti-NogoA treatment showed significantly better results in terms of functional recovery, fiber tract integrity, axonal sprouting and white matter repair markers compared with the control group at 28 days. White matter integrity was in part restored by antibody-mediated inhibition of NogoA administration in those animals that were subjected to an axonal injury by subcortical stroke. This white matter restoration triggered functional recovery.

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“…[18] Thus the DWI lesions on an MRI scan 24 hours after a stroke may represent a heterogeneous population of lesions with varying clinical outcomes that are not best captured by final infarct volume. [19] MRIs collected at 24 hours after the event may lack the critical information to determine if there has been a clinical benefit. If this is true, then it is important to consider this when designing clinical trials that are planning to use imaging biomarkers of response to therapy.…”

Section: Discussionmentioning

confidence: 99%

Early Change in Stroke Size Performs Best in Predicting Response to Therapy

et al. 2017

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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.

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Intralesional Patterns of MRI ADC Maps Predict Outcome in Experimental Stroke

Cited by 14 publications

References 23 publications

DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

NogoA Neutralization Promotes Axonal Restoration After White Matter Injury In Subcortical Stroke

Early Change in Stroke Size Performs Best in Predicting Response to Therapy

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