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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR)
signal intensities in acute stroke for the prediction of time from symptom onset</title><author><name sortKey="Cheng, Bastian" sort="Cheng, Bastian" uniqKey="Cheng B" first="Bastian" last="Cheng">Bastian Cheng</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Brinkmann, Mathias" sort="Brinkmann, Mathias" uniqKey="Brinkmann M" first="Mathias" last="Brinkmann">Mathias Brinkmann</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Forkert, Nils D" sort="Forkert, Nils D" uniqKey="Forkert N" first="Nils D" last="Forkert">Nils D. Forkert</name><affiliation><nlm:aff id="aff2"><institution>Institut für Computational Neuroscience, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Treszl, Andras" sort="Treszl, Andras" uniqKey="Treszl A" first="Andras" last="Treszl">Andras Treszl</name><affiliation><nlm:aff id="aff3"><institution>Institut für Medizinische Biometrie und Epidemiologie, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Ebinger, Martin" sort="Ebinger, Martin" uniqKey="Ebinger M" first="Martin" last="Ebinger">Martin Ebinger</name><affiliation><nlm:aff id="aff4"><institution>Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin</institution>, Berlin,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Kohrmann, Martin" sort="Kohrmann, Martin" uniqKey="Kohrmann M" first="Martin" last="Köhrmann">Martin Köhrmann</name><affiliation><nlm:aff id="aff5"><institution>Klinik für Neurologie, Universität Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Wu, Ona" sort="Wu, Ona" uniqKey="Wu O" first="Ona" last="Wu">Ona Wu</name><affiliation><nlm:aff id="aff6"><institution>Athinoula A MartinosCenter for Biomedical Imaging, Department of Radiology, Massachusetts GeneralHospital, Harvard MedicalSchool</institution>, Boston, Massachusetts,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Kang, Dong Wha" sort="Kang, Dong Wha" uniqKey="Kang D" first="Dong-Wha" last="Kang">Dong-Wha Kang</name><affiliation><nlm:aff id="aff7"><institution>Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine</institution>, Seoul,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Liebeskind, David S" sort="Liebeskind, David S" uniqKey="Liebeskind D" first="David S" last="Liebeskind">David S. Liebeskind</name><affiliation><nlm:aff id="aff8"><institution>Department of Neurology, University of California</institution>, Oakland, California,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Tourdias, Thomas" sort="Tourdias, Thomas" uniqKey="Tourdias T" first="Thomas" last="Tourdias">Thomas Tourdias</name><affiliation><nlm:aff id="aff9"><institution>University de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Place Amélie Raba Léon</institution>, Bordeaux,<country>France</country></nlm:aff></affiliation></author><author><name sortKey="Singer, Oliver C" sort="Singer, Oliver C" uniqKey="Singer O" first="Oliver C" last="Singer">Oliver C. Singer</name><affiliation><nlm:aff id="aff10"><institution>Kliniken für Neuroradiologie, Universitätsklinikum Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Christensen, Soren" sort="Christensen, Soren" uniqKey="Christensen S" first="Soren" last="Christensen">Soren Christensen</name><affiliation><nlm:aff id="aff11"><institution>Department of Neurology, Royal Melbourne Hospital, University of Melbourne</institution>, Parkville, Victoria,<country>Australia</country></nlm:aff></affiliation></author><author><name sortKey="Luby, Marie" sort="Luby, Marie" uniqKey="Luby M" first="Marie" last="Luby">Marie Luby</name><affiliation><nlm:aff id="aff12"><institution>National Institute of Neurological Disorders and Stroke</institution>, Bethesda, Maryland,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Warach, Steven" sort="Warach, Steven" uniqKey="Warach S" first="Steven" last="Warach">Steven Warach</name><affiliation><nlm:aff id="aff12"><institution>National Institute of Neurological Disorders and Stroke</institution>, Bethesda, Maryland,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Fiehler, Jens" sort="Fiehler, Jens" uniqKey="Fiehler J" first="Jens" last="Fiehler">Jens Fiehler</name><affiliation><nlm:aff id="aff13"><institution>Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Fiebach, Jochen B" sort="Fiebach, Jochen B" uniqKey="Fiebach J" first="Jochen B" last="Fiebach">Jochen B. Fiebach</name><affiliation><nlm:aff id="aff4"><institution>Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin</institution>, Berlin,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Thomalla, Gotz" sort="Thomalla, Gotz" uniqKey="Thomalla G" first="Götz" last="Thomalla">Götz Thomalla</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23047272</idno><idno type="pmc">3965287</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965287</idno><idno type="RBID">PMC:3965287</idno><idno type="doi">10.1038/jcbfm.2012.129</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000070</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000070</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR)
signal intensities in acute stroke for the prediction of time from symptom onset</title><author><name sortKey="Cheng, Bastian" sort="Cheng, Bastian" uniqKey="Cheng B" first="Bastian" last="Cheng">Bastian Cheng</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Brinkmann, Mathias" sort="Brinkmann, Mathias" uniqKey="Brinkmann M" first="Mathias" last="Brinkmann">Mathias Brinkmann</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Forkert, Nils D" sort="Forkert, Nils D" uniqKey="Forkert N" first="Nils D" last="Forkert">Nils D. Forkert</name><affiliation><nlm:aff id="aff2"><institution>Institut für Computational Neuroscience, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Treszl, Andras" sort="Treszl, Andras" uniqKey="Treszl A" first="Andras" last="Treszl">Andras Treszl</name><affiliation><nlm:aff id="aff3"><institution>Institut für Medizinische Biometrie und Epidemiologie, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Ebinger, Martin" sort="Ebinger, Martin" uniqKey="Ebinger M" first="Martin" last="Ebinger">Martin Ebinger</name><affiliation><nlm:aff id="aff4"><institution>Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin</institution>, Berlin,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Kohrmann, Martin" sort="Kohrmann, Martin" uniqKey="Kohrmann M" first="Martin" last="Köhrmann">Martin Köhrmann</name><affiliation><nlm:aff id="aff5"><institution>Klinik für Neurologie, Universität Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Wu, Ona" sort="Wu, Ona" uniqKey="Wu O" first="Ona" last="Wu">Ona Wu</name><affiliation><nlm:aff id="aff6"><institution>Athinoula A MartinosCenter for Biomedical Imaging, Department of Radiology, Massachusetts GeneralHospital, Harvard MedicalSchool</institution>, Boston, Massachusetts,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Kang, Dong Wha" sort="Kang, Dong Wha" uniqKey="Kang D" first="Dong-Wha" last="Kang">Dong-Wha Kang</name><affiliation><nlm:aff id="aff7"><institution>Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine</institution>, Seoul,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Liebeskind, David S" sort="Liebeskind, David S" uniqKey="Liebeskind D" first="David S" last="Liebeskind">David S. Liebeskind</name><affiliation><nlm:aff id="aff8"><institution>Department of Neurology, University of California</institution>, Oakland, California,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Tourdias, Thomas" sort="Tourdias, Thomas" uniqKey="Tourdias T" first="Thomas" last="Tourdias">Thomas Tourdias</name><affiliation><nlm:aff id="aff9"><institution>University de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Place Amélie Raba Léon</institution>, Bordeaux,<country>France</country></nlm:aff></affiliation></author><author><name sortKey="Singer, Oliver C" sort="Singer, Oliver C" uniqKey="Singer O" first="Oliver C" last="Singer">Oliver C. Singer</name><affiliation><nlm:aff id="aff10"><institution>Kliniken für Neuroradiologie, Universitätsklinikum Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Christensen, Soren" sort="Christensen, Soren" uniqKey="Christensen S" first="Soren" last="Christensen">Soren Christensen</name><affiliation><nlm:aff id="aff11"><institution>Department of Neurology, Royal Melbourne Hospital, University of Melbourne</institution>, Parkville, Victoria,<country>Australia</country></nlm:aff></affiliation></author><author><name sortKey="Luby, Marie" sort="Luby, Marie" uniqKey="Luby M" first="Marie" last="Luby">Marie Luby</name><affiliation><nlm:aff id="aff12"><institution>National Institute of Neurological Disorders and Stroke</institution>, Bethesda, Maryland,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Warach, Steven" sort="Warach, Steven" uniqKey="Warach S" first="Steven" last="Warach">Steven Warach</name><affiliation><nlm:aff id="aff12"><institution>National Institute of Neurological Disorders and Stroke</institution>, Bethesda, Maryland,<country>USA</country></nlm:aff></affiliation></author><author><name sortKey="Fiehler, Jens" sort="Fiehler, Jens" uniqKey="Fiehler J" first="Jens" last="Fiehler">Jens Fiehler</name><affiliation><nlm:aff id="aff13"><institution>Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Fiebach, Jochen B" sort="Fiebach, Jochen B" uniqKey="Fiebach J" first="Jochen B" last="Fiebach">Jochen B. Fiebach</name><affiliation><nlm:aff id="aff4"><institution>Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin</institution>, Berlin,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author><author><name sortKey="Thomalla, Gotz" sort="Thomalla, Gotz" uniqKey="Thomalla G" first="Götz" last="Thomalla">Götz Thomalla</name><affiliation><nlm:aff id="aff1"><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Cerebral Blood Flow & Metabolism</title><idno type="ISSN">0271-678X</idno><idno type="eISSN">1559-7016</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>In acute stroke magnetic resonance imaging, a ‘mismatch' between visibility
of an ischemic lesion on diffusion-weighted imaging (DWI) and missing corresponding
parenchymal hyperintensities on fluid-attenuated inversion recovery (FLAIR) data sets was
shown to identify patients with time from symptom onset ≤4.5 hours with high
specificity. However, moderate sensitivity and suboptimal interpreter agreement are
limitations of a visual rating of FLAIR lesion visibility. We tested refined image
analysis methods in patients included in the previously published PREFLAIR study using
refined visual analysis and quantitative measurements of relative FLAIR signal intensity
(rSI) from a three-dimensional, segmented stroke lesion volume. A total of 399 patients
were included. The rSI of FLAIR lesions showed a moderate correlation with time from
symptom onset (<italic>r</italic>=0.382, <italic>P</italic><0.001). A FLAIR rSI threshold of
<1.0721 predicted symptom onset ≤4.5 hours with slightly increased
specificity (0.85 versus 0.78) but also slightly decreased sensitivity (0.47 versus 0.58)
as compared with visual analysis. Refined visual analysis differentiating between
‘subtle' and ‘obvious' FLAIR hyperintensities and classification
and regression tree algorithms combining information from visual and quantitative analysis
also did not improve diagnostic accuracy. Our results raise doubts whether the prediction
of stroke onset time by visual image judgment can be improved by quantitative rSI
measurements.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Cereb Blood Flow Metab</journal-id><journal-id journal-id-type="iso-abbrev">J. Cereb. Blood Flow Metab</journal-id><journal-title-group><journal-title>Journal of Cerebral Blood Flow & Metabolism</journal-title></journal-title-group><issn pub-type="ppub">0271-678X</issn><issn pub-type="epub">1559-7016</issn><publisher><publisher-name>Nature Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23047272</article-id><article-id pub-id-type="pmc">3965287</article-id><article-id pub-id-type="pii">jcbfm2012129</article-id><article-id pub-id-type="doi">10.1038/jcbfm.2012.129</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Quantitative measurements of relative fluid-attenuated inversion recovery (FLAIR)
signal intensities in acute stroke for the prediction of time from symptom onset</article-title><alt-title alt-title-type="running">Quantitative FLAIR measurements in acute stroke</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cheng</surname><given-names>Bastian</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="caf1">*</xref></contrib><contrib contrib-type="author"><name><surname>Brinkmann</surname><given-names>Mathias</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Forkert</surname><given-names>Nils D</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Treszl</surname><given-names>Andras</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ebinger</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Köhrmann</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Ona</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Dong-Wha</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Liebeskind</surname><given-names>David S</given-names></name><xref ref-type="aff" rid="aff8">8</xref></contrib><contrib contrib-type="author"><name><surname>Tourdias</surname><given-names>Thomas</given-names></name><xref ref-type="aff" rid="aff9">9</xref></contrib><contrib contrib-type="author"><name><surname>Singer</surname><given-names>Oliver C</given-names></name><xref ref-type="aff" rid="aff10">10</xref></contrib><contrib contrib-type="author"><name><surname>Christensen</surname><given-names>Soren</given-names></name><xref ref-type="aff" rid="aff11">11</xref></contrib><contrib contrib-type="author"><name><surname>Luby</surname><given-names>Marie</given-names></name><xref ref-type="aff" rid="aff12">12</xref></contrib><contrib contrib-type="author"><name><surname>Warach</surname><given-names>Steven</given-names></name><xref ref-type="aff" rid="aff12">12</xref></contrib><contrib contrib-type="author"><name><surname>Fiehler</surname><given-names>Jens</given-names></name><xref ref-type="aff" rid="aff13">13</xref></contrib><contrib contrib-type="author"><name><surname>Fiebach</surname><given-names>Jochen B</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Gerloff</surname><given-names>Christian</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Thomalla</surname><given-names>Götz</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><on-behalf-of>for the STIR and VISTA Imaging Investigators</on-behalf-of><aff id="aff1"><label>1</label><institution>Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></aff><aff id="aff2"><label>2</label><institution>Institut für Computational Neuroscience, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></aff><aff id="aff3"><label>3</label><institution>Institut für Medizinische Biometrie und Epidemiologie, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></aff><aff id="aff4"><label>4</label><institution>Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin</institution>, Berlin,<country>Germany</country></aff><aff id="aff5"><label>5</label><institution>Klinik für Neurologie, Universität Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></aff><aff id="aff6"><label>6</label><institution>Athinoula A MartinosCenter for Biomedical Imaging, Department of Radiology, Massachusetts GeneralHospital, Harvard MedicalSchool</institution>, Boston, Massachusetts,<country>USA</country></aff><aff id="aff7"><label>7</label><institution>Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine</institution>, Seoul,<country>South Korea</country></aff><aff id="aff8"><label>8</label><institution>Department of Neurology, University of California</institution>, Oakland, California,<country>USA</country></aff><aff id="aff9"><label>9</label><institution>University de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Place Amélie Raba Léon</institution>, Bordeaux,<country>France</country></aff><aff id="aff10"><label>10</label><institution>Kliniken für Neuroradiologie, Universitätsklinikum Erlangen-Nürnberg</institution>, Erlangen,<country>Germany</country></aff><aff id="aff11"><label>11</label><institution>Department of Neurology, Royal Melbourne Hospital, University of Melbourne</institution>, Parkville, Victoria,<country>Australia</country></aff><aff id="aff12"><label>12</label><institution>National Institute of Neurological Disorders and Stroke</institution>, Bethesda, Maryland,<country>USA</country></aff><aff id="aff13"><label>13</label><institution>Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf</institution>, Hamburg,<country>Germany</country></aff></contrib-group><author-notes><corresp id="caf1"><label>*</label><institution>Klinik und Poliklinik für Neurologie, Kopf- und
Neurozentrum, Universitätsklinikum Hamburg-Eppendorf</institution>, Martinistr.
52, Hamburg
20246, <country>Germany</country>. E-mail: <email>b.cheng@uke.uni-hamburg.de</email></corresp><fn fn-type="present-address" id="note1"><label>14</label><p>See <xref ref-type="app" rid="app1">Appendix</xref>.</p></fn></author-notes><pub-date pub-type="ppub"><month>01</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>10</day><month>10</month><year>2012</year></pub-date><volume>33</volume><issue>1</issue><fpage>76</fpage><lpage>84</lpage><history><date date-type="received"><day>02</day><month>07</month><year>2012</year></date><date date-type="rev-recd"><day>11</day><month>08</month><year>2012</year></date><date date-type="accepted"><day>14</day><month>08</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2013 International Society for Cerebral Blood Flow & Metabolism, Inc.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>International Society for Cerebral Blood Flow & Metabolism, Inc.</copyright-holder></permissions><abstract><p>In acute stroke magnetic resonance imaging, a ‘mismatch' between visibility
of an ischemic lesion on diffusion-weighted imaging (DWI) and missing corresponding
parenchymal hyperintensities on fluid-attenuated inversion recovery (FLAIR) data sets was
shown to identify patients with time from symptom onset ≤4.5 hours with high
specificity. However, moderate sensitivity and suboptimal interpreter agreement are
limitations of a visual rating of FLAIR lesion visibility. We tested refined image
analysis methods in patients included in the previously published PREFLAIR study using
refined visual analysis and quantitative measurements of relative FLAIR signal intensity
(rSI) from a three-dimensional, segmented stroke lesion volume. A total of 399 patients
were included. The rSI of FLAIR lesions showed a moderate correlation with time from
symptom onset (<italic>r</italic>=0.382, <italic>P</italic><0.001). A FLAIR rSI threshold of
<1.0721 predicted symptom onset ≤4.5 hours with slightly increased
specificity (0.85 versus 0.78) but also slightly decreased sensitivity (0.47 versus 0.58)
as compared with visual analysis. Refined visual analysis differentiating between
‘subtle' and ‘obvious' FLAIR hyperintensities and classification
and regression tree algorithms combining information from visual and quantitative analysis
also did not improve diagnostic accuracy. Our results raise doubts whether the prediction
of stroke onset time by visual image judgment can be improved by quantitative rSI
measurements.</p></abstract><kwd-group><kwd>acute stroke</kwd><kwd>diffusion-weighted imaging</kwd><kwd>fluid-attenuated inversion recovery</kwd><kwd>magnetic resonance imaging</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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