Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics
Authors
Anna K. Bonkhoff, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Teresa Ullberg, Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
Martin Bretzner, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Sungmin Hong, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Markus D. Schirmer, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Robert W. Regenhardt, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Kathleen L. Donahue, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Marco J. Nardin, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Adrian V. Dalca, Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, United States.
Anne-Katrin Giese, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Mark R. Etherton, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Brandon L. Hancock, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.
Steven J. Mocking, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.
Elissa C. McIntosh, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, United States.
John Attia, Hunter Medical Research Institute, Newcastle, NSW, Australia.
John W. Cole, Department of Neurology, University of Maryland, School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States.
Amanda Donatti, School of Medical Sciences, The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas (UNICAMP), Campinas, Brazil.
Christoph J. Griessenauer, Department of Neurosurgery, Geisinger, Danville, PA, United States.
Laura Heitsch, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States.
Lukas Holmegaard, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Katarina Jood, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Jordi Jimenez-Conde, Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Pompeu Fabra, Barcelona, Spain.
Steven J. Kittner, Department of Neurology, University of Maryland, School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States.
Robin Lemmens, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience, Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium.
Christopher R. Levi, Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.
Caitrin W. McDonough, Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
James F. Meschia, Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria.
Chia-Ling Phuah, Department of Neurology, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States.
Stefan Ropele, Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States.
Jonathan Rosand, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Jaume Roquer, Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Pompeu Fabra, Barcelona, Spain.
Abstract
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, < 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. 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.
Publication Date
1-1-2022
Publication Title
Frontiers in neuroscience
Digital Object Identifier (DOI)
10.3389/fnins.2022.994458
Recommended Citation
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.; 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; and Roquer, Jaume, "Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics" (2022). Neurology. 1719.
https://scholar.barrowneuro.org/neurology/1719
