title: Fluid-Attenuated Inversion Recovery Vascular Hyperintensities-Diffusion-Weighted Imaging Mismatch Identifies Acute Stroke Patients Most Likely to Benefit From Recanalization.
abstract: OBJECTIVE
  Fluid-attenuated inversion recovery vascular hyperintensities (FVH) beyond the boundaries of diffusion-weighted imaging (DWI) lesion (FVH-DWI mismatch) have been proposed as an alternative to perfusion-weighted imaging (PWI)-DWI mismatch. We aimed to establish whether FVH-DWI mismatch can identify patients most likely to benefit from recanalization.
  
  
  METHODS
  FVH-DWI mismatch was assessed in 164 patients with proximal middle cerebral artery occlusion before intravenous thrombolysis. PWI-DWI mismatch (PWITmax>6sec/DWI>1.8) was assessed in the 104 patients with available PWI data. We tested the associations between 24-hours complete recanalization on magnetic resonance angiography and 3-month favorable outcome (modified Rankin Scale score ≤2), stratified on FVH-DWI (or PWI-DWI) status.
  
  
  RESULTS
  FVH-DWI mismatch was present in 121/164 (74%) patients and recanalization in 50/164 (30%) patients. The odds ratio for favorable outcome with recanalization was 16.2 (95% confidence interval, 5.7-46.5; P<0.0001) in patients with FVH-DWI mismatch and 2.6 (95% confidence interval, 0.6-12.1; P=0.22) in those without FVH-DWI mismatch (P=0.048 for interaction). Recanalization was associated with favorable outcome in patients with PWI-DWI mismatch (odds ratios, 9.9; 95% confidence interval, 3.1-31.3; P=0.0001) and in patients without PWI-DWI mismatch (odds ratios, 7.0; 95% confidence interval, 1.1-44.1; P=0.047), P=0.76 for interaction.
  
  
  CONCLUSIONS
  The FVH-DWI mismatch may rapidly identify patients with proximal occlusion most likely to benefit from recanalization.
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Legrand
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Tisserand
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Turc
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Edjlali
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Calvet
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Trystram
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Roca
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Méder
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.affiliation: From the Departments of Radiology (L.L., M.T., M.E., D.T., P.R., O.N., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Université Paris-Descartes Sorbonne-Paris-Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, DHU Neurovasc, Paris, France. c.oppenheim@ch-sainte-anne.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000188:drug therapy; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: infarction; magnetic resonance angiography; magnetic resonance imaging; perfusion imaging; thrombolysis