Evidence map›Paper›PMID 28683442›Full record

Observational studyCerebrovascular diseases (Basel, Switzerland)2017

Early Change in Stroke Size Performs Best in Predicting Response to Therapy.

Alexis Nétis Simpkins, Christian Dias, Gina Norato, Eunhee Kim, Richard Leigh, NIH Natural History of Stroke Investigators

Abstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Cerebrovascular diseases (Basel, Switzerland), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
  5. Ischemic lesion growth in acute stroke: Water uptake quantification distinguishes between edema and tissue infarct.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2020
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Alexis Nétis SimpkinsNeuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Christian Dias
Gina Norato
Eunhee Kim
Richard Leigh
NIH Natural History of Stroke Investigators

Funding

CLINICAL AND IMAGING CORE SUPPORT OF ACUTE STROKE RESEARCHZICNS003044 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI LATOUR, LAWRENCE · 2015 to 2025
$32.8M
NOVEL INSIGHTS INTO CEREBRAL ISCHEMIC PATHOPHYSIOLOGY IN HUMANSZIANS003043 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI LATOUR, LAWRENCE · 2009 to 2025
$19.5M
Using MRI to Understand Disease States that Occur at the Interface of the Brain and the Cerebral CirculationZIANS003151 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI LEIGH, RICHARD · 2015 to 2023
$6.8M
Intramural NIH HHS Z99 NS999999Intramural NIH HHS ZIA NS003151
6 · The paper itself

Abstract

backgroundReliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI).

methodsAcute stroke patients, enrolled between 2013 and 2014 with serial magnetic resonance imaging (MRI) scans (pretreatment baseline, 2 h post, and 24 h post), who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 h on diffusion, and percent of early reperfusion were calculated from the baseline and 2 h MRI scans were compared. ENI was defined as ≥4 point decrease in National Institutes of Health Stroke Scales within 24 h. Logistic regression models and receiver operator characteristics analysis were used to compare the efficacy of 3 imaging biomarkers.

resultsSerial MRIs of 58 acute stroke patients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (OR 0.93, p = 0.048) and remained significant after controlling for stroke size and severity (OR 0.90, p = 0.032). Thus, for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 h nor percent of early reperfusion were significantly associated with ENI by logistic regression. Receiver-operator characteristic analysis identified early change in stroke volume as the only biomarker of the 3 that performed significantly different than chance (p = 0.03).

conclusionsEarly fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the more traditional measures of final infarct volume and percent of early reperfusion.

Indexed as

Diffusion Magnetic Resonance ImagingThrombolytic TherapyAgedAged, 80 and overArea Under CurveBrainCerebrovascular CirculationDisability EvaluationFemaleHumansLogistic ModelsMagnetic Resonance AngiographyMaleMiddle AgedMultivariate AnalysisOdds RatioBrain imagingBrain ischemiaDiffusion-weighted magnetic resonance imagingMagnetic resonance imagingStroke

Identifiers

PMID28683442
PMCPMC5629107

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.