Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensity Can Identify Stroke Within 6 and 8 Hours

John Legge, Ada Graham, Shailesh Male, David Copeland, Richard Lee, Nitin Goyal, Ramin Zand

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Patients with wake-up or unknown time of onset stroke are usually excluded from recanalization. However, a few studies indicate that some magnetic resonance sequences can help predict time from symptom onset (SxO). Our goal was to assess the value of fluid-attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying patients within 6 and 8 hours of stroke onset. Materials and Methods: We studied consecutive acute stroke patients with known time of onset who underwent magnetic resonance imaging (MRI) within 48 hours of SxO. SIR was calculated as the value of the FLAIR signal intensity of the identified area of infarction divided by the signal intensity in the homologous contralateral side of the brain. Results: Out of 160 patients included in this study, 72 and 80 patients had MRI within 6 and 8 hours of SxO, respectively. We found a positive correlation between SIR and time from SxO (Pearson coefficient, .63). Receiver operating characteristic curves indicated that SIR ≤ 1.18 could accurately identify patients within 6 hours of SxO (86% sensitivity, 79% specificity) and a SIR ≤ 1.20 can be identified within 8 hours (89% sensitivity, 76% specificity). Among patients with no visible FLAIR hyperintensity, 83% (95% CI, 77%-89%) were within the 6-hour window. Conclusion: Quantitative assessment of FLAIR sequence can be used to identify patients within 6 and 8 hours of stroke onset.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Sep 16 2016

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Stroke
Magnetic Resonance Imaging
Sequence Inversion
Sensitivity and Specificity
ROC Curve
Infarction
Magnetic Resonance Spectroscopy
Brain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensity Can Identify Stroke Within 6 and 8 Hours. / Legge, John; Graham, Ada; Male, Shailesh; Copeland, David; Lee, Richard; Goyal, Nitin; Zand, Ramin.

In: Journal of Stroke and Cerebrovascular Diseases, 16.09.2016.

Research output: Contribution to journalArticle

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abstract = "Background: Patients with wake-up or unknown time of onset stroke are usually excluded from recanalization. However, a few studies indicate that some magnetic resonance sequences can help predict time from symptom onset (SxO). Our goal was to assess the value of fluid-attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying patients within 6 and 8 hours of stroke onset. Materials and Methods: We studied consecutive acute stroke patients with known time of onset who underwent magnetic resonance imaging (MRI) within 48 hours of SxO. SIR was calculated as the value of the FLAIR signal intensity of the identified area of infarction divided by the signal intensity in the homologous contralateral side of the brain. Results: Out of 160 patients included in this study, 72 and 80 patients had MRI within 6 and 8 hours of SxO, respectively. We found a positive correlation between SIR and time from SxO (Pearson coefficient, .63). Receiver operating characteristic curves indicated that SIR ≤ 1.18 could accurately identify patients within 6 hours of SxO (86{\%} sensitivity, 79{\%} specificity) and a SIR ≤ 1.20 can be identified within 8 hours (89{\%} sensitivity, 76{\%} specificity). Among patients with no visible FLAIR hyperintensity, 83{\%} (95{\%} CI, 77{\%}-89{\%}) were within the 6-hour window. Conclusion: Quantitative assessment of FLAIR sequence can be used to identify patients within 6 and 8 hours of stroke onset.",
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T1 - Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensity Can Identify Stroke Within 6 and 8 Hours

AU - Legge, John

AU - Graham, Ada

AU - Male, Shailesh

AU - Copeland, David

AU - Lee, Richard

AU - Goyal, Nitin

AU - Zand, Ramin

PY - 2016/9/16

Y1 - 2016/9/16

N2 - Background: Patients with wake-up or unknown time of onset stroke are usually excluded from recanalization. However, a few studies indicate that some magnetic resonance sequences can help predict time from symptom onset (SxO). Our goal was to assess the value of fluid-attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying patients within 6 and 8 hours of stroke onset. Materials and Methods: We studied consecutive acute stroke patients with known time of onset who underwent magnetic resonance imaging (MRI) within 48 hours of SxO. SIR was calculated as the value of the FLAIR signal intensity of the identified area of infarction divided by the signal intensity in the homologous contralateral side of the brain. Results: Out of 160 patients included in this study, 72 and 80 patients had MRI within 6 and 8 hours of SxO, respectively. We found a positive correlation between SIR and time from SxO (Pearson coefficient, .63). Receiver operating characteristic curves indicated that SIR ≤ 1.18 could accurately identify patients within 6 hours of SxO (86% sensitivity, 79% specificity) and a SIR ≤ 1.20 can be identified within 8 hours (89% sensitivity, 76% specificity). Among patients with no visible FLAIR hyperintensity, 83% (95% CI, 77%-89%) were within the 6-hour window. Conclusion: Quantitative assessment of FLAIR sequence can be used to identify patients within 6 and 8 hours of stroke onset.

AB - Background: Patients with wake-up or unknown time of onset stroke are usually excluded from recanalization. However, a few studies indicate that some magnetic resonance sequences can help predict time from symptom onset (SxO). Our goal was to assess the value of fluid-attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying patients within 6 and 8 hours of stroke onset. Materials and Methods: We studied consecutive acute stroke patients with known time of onset who underwent magnetic resonance imaging (MRI) within 48 hours of SxO. SIR was calculated as the value of the FLAIR signal intensity of the identified area of infarction divided by the signal intensity in the homologous contralateral side of the brain. Results: Out of 160 patients included in this study, 72 and 80 patients had MRI within 6 and 8 hours of SxO, respectively. We found a positive correlation between SIR and time from SxO (Pearson coefficient, .63). Receiver operating characteristic curves indicated that SIR ≤ 1.18 could accurately identify patients within 6 hours of SxO (86% sensitivity, 79% specificity) and a SIR ≤ 1.20 can be identified within 8 hours (89% sensitivity, 76% specificity). Among patients with no visible FLAIR hyperintensity, 83% (95% CI, 77%-89%) were within the 6-hour window. Conclusion: Quantitative assessment of FLAIR sequence can be used to identify patients within 6 and 8 hours of stroke onset.

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