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
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
Front Neurosci. 2022 Aug 25;16:994458. doi: 10.3389/fnins.2022.994458. eCollection 2022.
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.
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.
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, < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, = 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.
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.
大量急性缺血性卒中（AIS）患者存在多个急性病灶（MAL）。我们旨在对一个大型的经过放射学深度表型分析的队列中的MAL进行详细研究。
分析依赖于国际MRI-GENIE研究的影像和临床数据。影像数据包括用于估计白质高信号（WMH）负荷的液体衰减反转恢复（FLAIR）序列和用于评估急性卒中病灶的扩散加权成像（DWI）序列。第一步是系统评估一个和多个血管供应区域内MAL的发生情况。随后确定MAL与重要影像和临床特征之间的关联。通过贝叶斯分层回归模型估计单个和多个病灶状态与病灶体积之间对卒中严重程度和功能结局的交互作用。
我们分析了2466例患者（年龄=63.4±14.8岁，39%为女性），其中49.7%为单个病灶。另外37.4%在单个血管区域出现MAL，而12.9%在多个血管区域有病灶。在大多数区域，MAL的发生频率与单个病灶相同（比例约为1:1）。只有脑干区域MAL患者较少（比例为1:4）。MAL患者的病灶体积和急性美国国立卫生研究院卒中量表（NIHSS）评分显著更高（分别为7.7 vs. 1.7 ml和4 vs. 3，<0.001）。相比之下，单个病灶患者的WMH负荷显著更高（6.1 vs. 5.3 ml，P=0.048）。单个病灶与多个病灶患者的功能结局无显著差异。贝叶斯分析表明，在前循环卒中中，单个和多个病灶的病灶体积与卒中严重程度之间的关联相同。在后循环卒中中，仅在MAL患者中病灶体积与更高的NIHSS评分相关。
多个病灶，尤其是在单个血管区域内的病灶，发生频率比先前报道的更高。总体而言，多个病灶明显与更高的急性卒中严重程度、更高的总DWI病灶体积和更低的WMH病灶体积相关。在后循环卒中中，病灶体积仅与多个病灶中更高的卒中严重程度相关。
