title: Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke: 24-Hour Versus 1-Week Imaging.
abstract: Ischemic lesion volume (ILV) on noncontrast computed tomography at 1 week can be used as a secondary outcome measure in patients with acute ischemic stroke. Twenty-four-hour ILV on noncontrast computed tomography has greater availability and potentially allows earlier estimation of functional outcome. We aimed to assess lesion growth 24 hours after stroke onset and compare the associations of 24-hour and 1-week ILV with functional outcome.
  
  
  
  We included 228 patients from MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), who received noncontrast computed tomography at 24-hour and 1-week follow-up on which ILV was measured. Relative and absolute lesion growth was determined. Logistic regression models were constructed either including the 24-hour or including the 1-week ILV. Ordinal and dichotomous (0-2 and 3-6) modified Rankin scale scores were, respectively, used as primary and secondary outcome measures.
  
  
  
  Median ILV was 42 mL (interquartile range, 21-95 mL) and 64 mL (interquartile range: 30-120 mL) at 24 hours and 1 week, respectively. Relative lesion growth exceeding 30% occurred in 121 patients (53%) and absolute lesion growth exceeding 20 mL occurred in 83 patients (36%). Both the 24-hour and 1-week ILVs were similarly significantly associated with functional outcome (bothP<0.001). In the logistic analyses, the areas under the curve of the receiver-operator characteristic curves were similar: 0.85 (95% confidence interval, 0.80-0.90) and 0.87 (95% confidence interval, 0.82-0.91) for including the 24-hour and 1-week ILV, respectively.
  
  
  
  Growth of ILV is common 24-hour poststroke onset. Nevertheless, the 24-hour ILV proved to be a valuable secondary outcome measure as it is equally strongly associated with functional outcome as the 1-week ILV.
  
  
  
  URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Amber
authors.initials: A
authors.lastname: Bucker
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Boers
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Joseph C J
authors.initials: JCJ
authors.lastname: Bot
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Zwam
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Diederik W J
authors.initials: DWJ
authors.lastname: Dippel
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Yvo B W E M
authors.initials: YBWEM
authors.lastname: Roos
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands.
authors.forename: Charles B L M
authors.initials: CBLM
authors.lastname: Majoie
authors.affiliation: From the Department of Radiology (A.B., A.M.B., O.A.B., C.B.L.M.M., H.A.M.), Department of Biomedical Engineering & Physics (A.B., A.M.B., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.B.); Department of Radiology, VU Medical Center, the Netherlands (J.C.J.B.); Department of Public Health (H.F.L., D.W.J.D.), Department of Radiology (A.v.d.L.), and Department of Neurology (O.A.B., D.W.J.D.), Erasmus MC University Medical Center, the Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); and Department of Radiology (O.A.B., W.H.v.Z.) and Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands. h.a.marquering@amc.uva.nl.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: biomarker; brain edema; edema; follow-up studies; stroke