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. 2023 Sep;58(3):838-847.
doi: 10.1002/jmri.28596. Epub 2023 Jan 10.

Predicting the Onset of Ischemic Stroke With Fast High-Resolution 3D MR Spectroscopic Imaging

Zengping Lin  1 , Ziyu Meng  1 , Tianyao Wang  2 , Rong Guo  3   4 , Yibo Zhao  3   5 , Yudu Li  3   5 , Bin Bo  1 , Yue Guan  1 , Jun Liu  2 , Hong Zhou  6 , Xin Yu  7 , David J Lin  8 , Zhi-Pei Liang  3   5 , Parashkev Nachev  9 , Yao Li  1
Affiliations

Predicting the Onset of Ischemic Stroke With Fast High-Resolution 3D MR Spectroscopic Imaging

Zengping Lin et al. J Magn Reson Imaging. 2023 Sep.

Abstract

Background: Neurometabolite concentrations provide a direct index of infarction progression in stroke. However, their relationship with stroke onset time remains unclear.

Purpose: To assess the temporal dynamics of N-acetylaspartate (NAA), creatine, choline, and lactate and estimate their value in predicting early (<6 hours) vs. late (6-24 hours) hyperacute stroke groups.

Study type: Cross-sectional cohort.

Population: A total of 73 ischemic stroke patients scanned at 1.8-302.5 hours after symptom onset, including 25 patients with follow-up scans.

Field strength/sequence: A 3 T/magnetization-prepared rapid acquisition gradient echo sequence for anatomical imaging, diffusion-weighted imaging and fluid-attenuated inversion recovery imaging for lesion delineation, and 3D MR spectroscopic imaging (MRSI) for neurometabolic mapping.

Assessment: Patients were divided into hyperacute (0-24 hours), acute (24 hours to 1 week), and subacute (1-2 weeks) groups, and into early (<6 hours) and late (6-24 hours) hyperacute groups. Bayesian logistic regression was used to compare classification performance between early and late hyperacute groups by using different combinations of neurometabolites as inputs.

Statistical tests: Linear mixed effects modeling was applied for group-wise comparisons between NAA, creatine, choline, and lactate. Pearson's correlation analysis was used for neurometabolites vs. time. P < 0.05 was considered statistically significant.

Results: Lesional NAA and creatine were significantly lower in subacute than in acute stroke. The main effects of time were shown on NAA (F = 14.321) and creatine (F = 12.261). NAA was significantly lower in late than early hyperacute patients, and was inversely related to time from symptom onset across both groups (r = -0.440). The decrease of NAA and increase of lactate were correlated with lesion volume (NAA: r = -0.472; lactate: r = 0.366) in hyperacute stroke. Discrimination was improved by combining NAA, creatine, and choline signals (area under the curve [AUC] = 0.90).

Data conclusion: High-resolution 3D MRSI effectively assessed the neurometabolite changes and discriminated early and late hyperacute stroke lesions.

Evidence level: 1.

Technical efficacy: Stage 2.

Keywords: ischemic stroke; magnetic resonance spectroscopy imaging; neurometabolites.

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References

REFERENCES

    1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke. Stroke 2019;50:344-418.
    1. Berner LP, Cho TH, Haesebaert J, et al. MRI assessment of ischemic lesion evolution within white and gray matter. Cerebrovasc Dis 2016;41:291-297.
    1. Allen LM, Hasso AN, Handwerker J, Farid H. Sequence-specific MR imaging findings that are useful in dating ischemic stroke. Radiographics 2012;32:1285-1297.
    1. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718.
    1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21.

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