Related Experiment Video
Updated: Jun 7, 2026
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Final cerebral infarct volume is predictable by MR imaging at 1 week
1Service de NeuroImagerie Diagnostique et Thérapeutique, Université Victor Segalen Bordeaux, CHU de Bordeaux, France. thomas.tourdias@chu-bordeaux.fr
Background And Purpose:
Stroke volume, an increasingly used end point in phase II trials, is considered stationary at least 30 days after the ictus. We investigated whether information conveyed by MR imaging measurements of the "final" infarct volume could be assessed as early as the subacute stage (days 3-6), rather than waiting for the chronic stage (days 30-45).
Materials And Methods:
Ninety-five patients with middle cerebral artery stroke prospectively included in a multicenter study underwent MR imaging during the first 12 hours (MR imaging-1), between days 3 and 6 (MR imaging-2), and between days 30 and 45 (MR imaging-3). We first investigated the relationship between subacute (FLAIR-2) and chronic volumes (FLAIR-3), by using a linear regression model. We then tested the relationship between FLAIR volumes (either FLAIR-2 or FLAIR-3) and functional disability, measured by the mRS at the time of MR imaging-3, by using logistic regression. The performances of the models were assessed by using the AUC in ROC.
Results:
A linear association between log FLAIR-2 and log FLAIR-3 volumes was observed. The proportion of FLAIR-3 variation, explained by FLAIR-2, was high (R(2) = 81%), without a covariate that improved this percentage. Both FLAIR-2 and FLAIR-3 were independent predictors of mRS (OR, 0.79 and 0.73; 95% CI, 0.64-0.97 and 0.56-0.96; P = .026 and .023). The performances of the models for the association between either FLAIR volume and mRS did not differ (AUC = 0.897 for FLAIR-2 and 0.888 for FLAIR-3).
Conclusions:
Stroke damage may be assessed by a subacute volume because subacute volume predicts the "true" final volume and provides the same clinical prognosis.
Insights
Subacute stroke volume measured by MRI predicts final infarct size and functional outcomes. This allows for earlier assessment of stroke damage and prognosis, streamlining clinical trials.
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.
