Evidence map›Paper›PMID 28957339›Full record

ArticlePloS one2017

Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment?

Julia Meisterernst, Pascal P Klinger-Gratz, Lars Leidolt, Matthias F Lang, Gerhard Schroth, Pasquale Mordasini, Mirjam R Heldner, Marie-Luise Mono, Rebekka Kurmann, Monika Buehlmann and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 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
0.5field-weighted citation impact, top 31% of its field
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, 7 citations in OpenAlex.

  1. Article
  2. Review
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  4. Article
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  6. Brain changes in depression.Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie
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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

16 authors at 1 institution in 1 country.

Julia MeisterernstDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Pascal P Klinger-GratzDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Lars LeidoltDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Matthias F LangDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Gerhard SchrothDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Pasquale MordasiniDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Mirjam R HeldnerDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Marie-Luise MonoDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Rebekka KurmannDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Monika BuehlmannDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Urs FischerDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Marcel ArnoldDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Jan GrallaDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Heinrich P MattleDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Marwan El-KoussyDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Simon JungDepartment of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.ORCID http://orcid.org/0000-0002-8288-6102
University of Bern · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeSome authors use FLAIR imaging to select patients for stroke treatment. However, the effect of hyperintensity on FLAIR images on outcome and bleeding has been addressed in only few studies with conflicting results.

methods466 patients with anterior circulation strokes were included in this study. They all were examined with MRI before intravenous or endovascular treatment. Baseline data and 3 months outcome were recorded prospectively. Focal T2 and FLAIR hyperintensities within the ischemic lesion were evaluated by two raters, and the PROACT II classification was applied to assess bleeding complications on follow up imaging. Logistic regression analysis was used to determine predictors of bleeding complications and outcome and to analyze the influence of T2 or FLAIR hyperintensity on outcome.

resultsFocal hyperintensities were found in 142 of 307 (46.3%) patients with T2 weighted imaging and in 89 of 159 (56%) patients with FLAIR imaging. Hyperintensity in the basal ganglia, especially in the lentiform nucleus, on T2 weighted imaging was the only independent predictor of any bleeding after reperfusion treatment (33.8% in patients with vs. 18.2% in those without; p = 0.003) and there was a non-significant trend for more bleedings in patients with FLAIR hyperintensity within the basal ganglia (p = 0.069). However, there was no association of hyperintensity on T2 weighted or FLAIR images and symptomatic bleeding or worse outcome.

conclusionOur results question the assumption that T2 or FLAIR hyperintensities within the ischemic lesion should be used to exclude patients from reperfusion therapy, especially not from endovascular treatment.

Indexed as

Patient SelectionAgedBiomarkersCerebral HemorrhageCerebral InfarctionDiffusion Magnetic Resonance ImagingFemaleHumansMaleTreatment OutcomeBiomarkers

Identifiers

PMID28957339
PMCPMC5619762
OpenAlexW2756704052

What OpenQuestion holds

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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.