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Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and
Anna K Bonkhoff1, Teresa Ullberg2,3, Martin Bretzner1,4
1J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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, p < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, p = 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.
Insights
Multiple acute lesions in ischemic stroke patients are more common than previously thought and indicate higher stroke severity. These findings highlight the importance of identifying multiple lesions for better patient outcomes.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Acute ischemic stroke (AIS) frequently presents with multiple acute lesions (MAL).
- Understanding the characteristics and implications of MAL is crucial for patient management.
Purpose of the Study:
- To investigate the occurrence and clinical significance of MAL in a large cohort of AIS patients.
- To analyze associations between MAL and imaging/clinical features.
Main Methods:
- Utilized imaging (FLAIR, DWI) and clinical data from the international MRI-GENIE study.
- Systematically evaluated MAL occurrence and associations with patient characteristics.
- Employed Bayesian hierarchical regression for interaction effect analysis.
Main Results:
- Nearly 50% of patients had a single lesion, while 37.4% had MAL in one territory and 12.9% in multiple territories.
- MAL correlated with higher lesion volume and acute NIHSS (National Institutes of Health Stroke Scale).
- Single lesions were associated with higher white matter hyperintensity (WMH) burden; functional outcomes did not differ significantly.
Conclusions:
- MAL, particularly within a single territory, is more frequent than previously reported.
- MAL is linked to increased stroke severity, higher DWI lesion volume, and lower WMH volume.
- In posterior circulation strokes, lesion volume impacts severity more in MAL cases.
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