Final cerebral infarct volume is predictable by MR imaging at 1 week

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Stroke volume is a key endpoint in clinical trials, typically assessed 30 days post-ictus.
• Current methods require waiting for the chronic stage (30-45 days) for final infarct volume measurement.
• Early assessment of stroke volume could expedite trial timelines.

Purpose of the Study:

• To determine if subacute Magnetic Resonance (MR) imaging infarct volumes (days 3-6) can predict final chronic infarct volumes (days 30-45).
• To assess if subacute infarct volumes correlate with functional disability (modified Rankin Scale - mRS).
• To evaluate the feasibility of early stroke volume assessment in clinical trials.

Main Methods:

• Ninety-five middle cerebral artery stroke patients underwent serial MR imaging at 12 hours, days 3-6, and days 30-45.
• Linear regression analyzed the relationship between subacute (FLAIR-2) and chronic (FLAIR-3) infarct volumes.
• Logistic regression assessed the association between FLAIR volumes and mRS scores.
• Receiver Operating Characteristic (ROC) analysis determined model performance using Area Under the Curve (AUC).

Main Results:

• A strong linear association was found between subacute and chronic infarct volumes (R² = 81%).
• Subacute FLAIR volumes independently predicted mRS scores, similar to chronic volumes.
• Model performance for predicting mRS was comparable for both subacute and chronic volumes (AUC ≈ 0.89).

Conclusions:

• Subacute infarct volume is a reliable predictor of final infarct volume.
• Early MR imaging assessment of stroke volume provides equivalent clinical prognosis to chronic assessment.
• Subacute stroke volume measurement can be utilized in clinical trials for earlier endpoint evaluation.