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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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Savary T, Fieux M, Douplat M, Tournegros R, Daubie S, Pavie D, Denoix L, Pialat JB, Tringali S. Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy. JAMA Netw Open 2023; 6:e239158. [PMID: 37079301 PMCID: PMC10119737 DOI: 10.1001/jamanetworkopen.2023.9158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
Importance There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]). Objectives To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later. Design, Setting, and Participants This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France. Interventions All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images. Main Outcomes and Measures The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described. Results Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP. Conclusions and Relevance These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.
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Affiliation(s)
- Thibault Savary
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Maxime Fieux
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Mondor Institute for Biomedical Research (IMRB), Créteil, France
- Centre National de la Recherche Scientifique (CNRS) Equipe Mixte de Recherche 7000, Créteil, France
| | - Marion Douplat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service des Urgences, Hospices Civils of Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Research on Healthcare Performance, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Unité Mixte de Recherche (UMR) Adés 7268, Aix-Marseille University, Etablissement Français du Sang–CNRS, Espace Éthique Méditerranéen, Marseille, France
| | - Romain Tournegros
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sophie Daubie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Dylan Pavie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Luna Denoix
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Pialat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Creatis CNRS UMR 5220, INSERM U1294, Université Lyon 1, Villeurbanne, France
| | - Stephane Tringali
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS Université Claude Bernard Lyon 1, Lyon, France
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Bani-Sadr A, Pavie D, Mechtouff L, Cappucci M, Hermier M, Ameli R, Derex L, De Bourguignon C, Cho TH, Eker O, Nighoghossian N, Berthezene Y. Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy. Eur Radiol 2023; 33:4502-4509. [PMID: 36633674 DOI: 10.1007/s00330-022-09387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy. METHODS HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4. RESULTS One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (p = 0.01) and larger FIV (p = 0.02). Good collaterals were associated with a smaller baseline ischemic core (p < 0.001), larger penumbra (p = 0.04), and smaller FIV (p < 0.001). Collateral status was not significantly associated with brush sign (p = 0.20) or with infarct growth (p = 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3]; p = 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6]; p = 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8-16.6], p = 0.006). CONCLUSIONS Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not. KEY POINTS • Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy. • Our results suggest that the brush sign-a surrogate marker of severe hypoperfusion-is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France. .,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,Research On Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University. Domaine Rockfeller, 8 Avenue Rockfeller, 69373 Cedex 08, Lyon, France
| | | | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
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