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Does b1000-b0 Mismatch Challenge Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery Mismatch in Stroke?

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  • Ana Filipa Geraldo
  • ,
  • Lise-Prune Berner
  • ,
  • Julie Haesebaert
  • ,
  • Aurélie Chabrol
  • ,
  • Tae-Hee Cho
  • ,
  • Laurent Derex
  • ,
  • Marc Hermier
  • ,
  • Guy Louis-Tisserand
  • ,
  • Leila Chamard
  • ,
  • Irene Klaerke Mikkelsen
  • Lars Ribe
  • ,
  • Leif Østergaard
  • Niels Hjort
  • Salvador Pedraza
  • ,
  • Götz Thomalla
  • ,
  • Jean-Claude Baron
  • ,
  • Norbert Nighoghossian
  • ,
  • Yves Berthèzene

BACKGROUND AND PURPOSE: Our aim was to explore whether the mismatch in lesion visibility between b1000 and b0 images is an alternative to mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery imaging as a surrogate marker of stroke age.

METHODS: We analyzed patients from the European multicenter I-KNOW database. Independent readers assessed the visibility of ischemic lesions of the anterior circulation on b0 and fluid-attenuated inversion recovery imaging images. The signal-intensity ratio for b0 and fluid-attenuated inversion recovery imaging images was also measured from the segmented stroke lesion volume on b1000 images.

RESULTS: This study included 112 patients (68 men; mean age, 67.4 years) with stroke onset within (n=85) or longer than (n=27) 4.5 hours. b1000-b0 mismatch identified patients within 4.5 hours of stroke onset with moderate sensitivity (72.9%; 95% confidence interval [CI], 63.5-82.4) and specificity (70.4%; 95% CI, 53.2-87.6), high positive predictive value (88.6%; 95% CI, 81.1-96.0), and low negative predictive value (45.2%; 95% CI, 30.2-60.3). Global comparison of b1000-b0 mismatch with diffusion-weighted imaging-fluid-attenuated inversion recovery imaging mismatch (considered the imaging gold standard) indicated high sensitivity (85.9%; 95% CI, 78.2-93.6), specificity (91.2%; 95% CI, 76.3-98.1), and positive predictive value (96.7%; 95% CI, 88.0-99.1) and moderate negative predictive value (73.8%; 95% CI, 60.5-87.1) of this new approach. b0 signal-intensity ratio (r=0.251; 95% CI, 0.069-0.417; P=0.008) was significantly although weakly correlated with delay between stroke onset and magnetic resonance imaging.

CONCLUSIONS: b1000-b0 mismatch may identify patients with ischemic stroke of the within 4.5 hours of onset with high positive predictive value, perhaps constituting an alternative imaging tissue clock.

Original languageEnglish
JournalStroke; a journal of cerebral circulation
ISSN0039-2499
DOIs
Publication statusPublished - Mar 2016

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