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Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics
BACKGROUND PURPOSE: A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort. MATERIALS AND METHODS: Analyses relied upon imaging and clinical data from the internationa...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453031/ https://www.ncbi.nlm.nih.gov/pubmed/36090258 http://dx.doi.org/10.3389/fnins.2022.994458 |
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author | Bonkhoff, Anna K. Ullberg, Teresa Bretzner, Martin Hong, Sungmin Schirmer, Markus D. Regenhardt, Robert W. Donahue, Kathleen L. Nardin, Marco J. Dalca, Adrian V. Giese, Anne-Katrin Etherton, Mark R. Hancock, Brandon L. Mocking, Steven J. T. McIntosh, Elissa C. Attia, John Cole, John W. Donatti, Amanda Griessenauer, Christoph J. Heitsch, Laura Holmegaard, Lukas Jood, Katarina Jimenez-Conde, Jordi Kittner, Steven J. Lemmens, Robin Levi, Christopher R. McDonough, Caitrin W. Meschia, James F. Phuah, Chia-Ling Ropele, Stefan Rosand, Jonathan Roquer, Jaume Rundek, Tatjana Sacco, Ralph L. Schmidt, Reinhold Sharma, Pankaj Slowik, Agnieszka Sousa, Alessandro Stanne, Tara M. Strbian, Daniel Tatlisumak, Turgut Thijs, Vincent Vagal, Achala Woo, Daniel Zand, Ramin McArdle, Patrick F. Worrall, Bradford B. Jern, Christina Lindgren, Arne G. Maguire, Jane Wu, Ona Frid, Petrea Rost, Natalia S. Wasselius, Johan |
author_facet | Bonkhoff, Anna K. Ullberg, Teresa Bretzner, Martin Hong, Sungmin Schirmer, Markus D. Regenhardt, Robert W. Donahue, Kathleen L. Nardin, Marco J. Dalca, Adrian V. Giese, Anne-Katrin Etherton, Mark R. Hancock, Brandon L. Mocking, Steven J. T. McIntosh, Elissa C. Attia, John Cole, John W. Donatti, Amanda Griessenauer, Christoph J. Heitsch, Laura Holmegaard, Lukas Jood, Katarina Jimenez-Conde, Jordi Kittner, Steven J. Lemmens, Robin Levi, Christopher R. McDonough, Caitrin W. Meschia, James F. Phuah, Chia-Ling Ropele, Stefan Rosand, Jonathan Roquer, Jaume Rundek, Tatjana Sacco, Ralph L. Schmidt, Reinhold Sharma, Pankaj Slowik, Agnieszka Sousa, Alessandro Stanne, Tara M. Strbian, Daniel Tatlisumak, Turgut Thijs, Vincent Vagal, Achala Woo, Daniel Zand, Ramin McArdle, Patrick F. Worrall, Bradford B. Jern, Christina Lindgren, Arne G. Maguire, Jane Wu, Ona Frid, Petrea Rost, Natalia S. Wasselius, Johan |
author_sort | Bonkhoff, Anna K. |
collection | PubMed |
description | BACKGROUND PURPOSE: A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort. MATERIALS AND METHODS: Analyses relied upon imaging and clinical data from the international MRI-GENIE study. Imaging data comprised both Fluid-attenuated inversion recovery (FLAIR) for white matter hyperintensity (WMH) burden estimation and diffusion-weighted imaging (DWI) sequences for the assessment of acute stroke lesions. The initial step featured the systematic evaluation of occurrences of MAL within one and several vascular supply territories. Associations between MAL and important imaging and clinical characteristics were subsequently determined. The interaction effect between single and multiple lesion status and lesion volume was estimated by means of Bayesian hierarchical regression modeling for both stroke severity and functional outcome. RESULTS: We analyzed 2,466 patients (age = 63.4 ± 14.8, 39% women), 49.7% of which presented with a single lesion. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in multiple vascular territories. Within most territories, MAL occurred as frequently as single lesions (ratio ∼1:1). Only the brainstem region comprised fewer patients with MAL (ratio 1:4). Patients with MAL presented with a significantly higher lesion volume and acute NIHSS (7.7 vs. 1.7 ml and 4 vs. 3, p(FDR) < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, p(FDR) = 0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In case of posterior circulation stroke, lesion volume was linked to a higher NIHSS only among those with MAL. CONCLUSION: Multiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher total DWI lesion volume and a lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only. |
format | Online Article Text |
id | pubmed-9453031 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94530312022-09-09 Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics Bonkhoff, Anna K. Ullberg, Teresa Bretzner, Martin Hong, Sungmin Schirmer, Markus D. Regenhardt, Robert W. Donahue, Kathleen L. Nardin, Marco J. Dalca, Adrian V. Giese, Anne-Katrin Etherton, Mark R. Hancock, Brandon L. Mocking, Steven J. T. McIntosh, Elissa C. Attia, John Cole, John W. Donatti, Amanda Griessenauer, Christoph J. Heitsch, Laura Holmegaard, Lukas Jood, Katarina Jimenez-Conde, Jordi Kittner, Steven J. Lemmens, Robin Levi, Christopher R. McDonough, Caitrin W. Meschia, James F. Phuah, Chia-Ling Ropele, Stefan Rosand, Jonathan Roquer, Jaume Rundek, Tatjana Sacco, Ralph L. Schmidt, Reinhold Sharma, Pankaj Slowik, Agnieszka Sousa, Alessandro Stanne, Tara M. Strbian, Daniel Tatlisumak, Turgut Thijs, Vincent Vagal, Achala Woo, Daniel Zand, Ramin McArdle, Patrick F. Worrall, Bradford B. Jern, Christina Lindgren, Arne G. Maguire, Jane Wu, Ona Frid, Petrea Rost, Natalia S. Wasselius, Johan Front Neurosci Neuroscience BACKGROUND PURPOSE: A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort. MATERIALS AND METHODS: Analyses relied upon imaging and clinical data from the international MRI-GENIE study. Imaging data comprised both Fluid-attenuated inversion recovery (FLAIR) for white matter hyperintensity (WMH) burden estimation and diffusion-weighted imaging (DWI) sequences for the assessment of acute stroke lesions. The initial step featured the systematic evaluation of occurrences of MAL within one and several vascular supply territories. Associations between MAL and important imaging and clinical characteristics were subsequently determined. The interaction effect between single and multiple lesion status and lesion volume was estimated by means of Bayesian hierarchical regression modeling for both stroke severity and functional outcome. RESULTS: We analyzed 2,466 patients (age = 63.4 ± 14.8, 39% women), 49.7% of which presented with a single lesion. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in multiple vascular territories. Within most territories, MAL occurred as frequently as single lesions (ratio ∼1:1). Only the brainstem region comprised fewer patients with MAL (ratio 1:4). Patients with MAL presented with a significantly higher lesion volume and acute NIHSS (7.7 vs. 1.7 ml and 4 vs. 3, p(FDR) < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, p(FDR) = 0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In case of posterior circulation stroke, lesion volume was linked to a higher NIHSS only among those with MAL. CONCLUSION: Multiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher total DWI lesion volume and a lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only. Frontiers Media S.A. 2022-08-25 /pmc/articles/PMC9453031/ /pubmed/36090258 http://dx.doi.org/10.3389/fnins.2022.994458 Text en Copyright © 2022 Bonkhoff, Ullberg, Bretzner, Hong, Schirmer, Regenhardt, Donahue, Nardin, Dalca, Giese, Etherton, Hancock, Mocking, McIntosh, Attia, Cole, Donatti, Griessenauer, Heitsch, Holmegaard, Jood, Jimenez-Conde, Kittner, Lemmens, Levi, McDonough, Meschia, Phuah, Ropele, Rosand, Roquer, Rundek, Sacco, Schmidt, Sharma, Slowik, Sousa, Stanne, Strbian, Tatlisumak, Thijs, Vagal, Woo, Zand, McArdle, Worrall, Jern, Lindgren, Maguire, Wu, Frid, Rost and Wasselius. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Bonkhoff, Anna K. Ullberg, Teresa Bretzner, Martin Hong, Sungmin Schirmer, Markus D. Regenhardt, Robert W. Donahue, Kathleen L. Nardin, Marco J. Dalca, Adrian V. Giese, Anne-Katrin Etherton, Mark R. Hancock, Brandon L. Mocking, Steven J. T. McIntosh, Elissa C. Attia, John Cole, John W. Donatti, Amanda Griessenauer, Christoph J. Heitsch, Laura Holmegaard, Lukas Jood, Katarina Jimenez-Conde, Jordi Kittner, Steven J. Lemmens, Robin Levi, Christopher R. McDonough, Caitrin W. Meschia, James F. Phuah, Chia-Ling Ropele, Stefan Rosand, Jonathan Roquer, Jaume Rundek, Tatjana Sacco, Ralph L. Schmidt, Reinhold Sharma, Pankaj Slowik, Agnieszka Sousa, Alessandro Stanne, Tara M. Strbian, Daniel Tatlisumak, Turgut Thijs, Vincent Vagal, Achala Woo, Daniel Zand, Ramin McArdle, Patrick F. Worrall, Bradford B. Jern, Christina Lindgren, Arne G. Maguire, Jane Wu, Ona Frid, Petrea Rost, Natalia S. Wasselius, Johan Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title | Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title_full | Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title_fullStr | Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title_full_unstemmed | Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title_short | Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics |
title_sort | deep profiling of multiple ischemic lesions in a large, multi-center cohort: frequency, spatial distribution, and associations to clinical characteristics |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453031/ https://www.ncbi.nlm.nih.gov/pubmed/36090258 http://dx.doi.org/10.3389/fnins.2022.994458 |
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