Validity of shape as a predictive biomarker of final infarct volume in acute ischemic stroke.
OBJECTIVE
This study examines whether lesion shape documented on magnetic resonance diffusion-weighted imaging during acute stroke improves the prediction of the final infarct volume compared with lesion volume only.


METHODS
Diffusion-weighted imaging data and clinical information were retrospectively reviewed in 110 consecutive patients who underwent (n=67) or not (n=43) thrombolytic therapy for acute ischemic stroke. Three-dimensional shape analysis was performed on admission diffusion-weighted imaging data and 5 shape descriptors were developed. Final infarct volume was measured on T2-fluid-attenuated inversion recovery imaging data performed 30 days after stroke.


RESULTS
Shape analysis of acute ischemic lesion and more specifically the ratio of the bounding box volume to the lesion volume before thrombolytic treatment improved the prediction of the final infarct for patients undergoing thrombolysis (R(2)=0.86 in model with volume; R(2)=0.98 in model with volume and shape).


CONCLUSIONS
Our findings suggest that lesion shape contains important predictive information and reflects important environmental factors that might determine the progression of ischemia from the core.
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Carole
C
Frindel
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Anaïs
A
Rouanet
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Mathilde
M
Giacalone
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Tae-Hee
TH
Cho
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Leif
L
Østergaard
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Jens
J
Fiehler
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Salvador
S
Pedraza
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Jean-Claude
JC
Baron
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Marlène
M
Wiart
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Yves
Y
Berthezène
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Norbert
N
Nighoghossian
From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.). david.rousseau@univ-lyon1.fr.
David
D
Rousseau
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000188:drug therapy / Q000473:pathology*; D015912:Thrombolytic Therapy
D015415:Biomarkers
MRI; stroke