Skip to main content

ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1445017

Large vessel occlusion mediated FLAIR signal intensity ratio is associated with stroke within 4.5 hours

Provisionally accepted
Yajing Wang Yajing Wang 1Qianqian Mao Qianqian Mao 1*Liang Jiang Liang Jiang 1Mingyang Peng Mingyang Peng 1*Yu-Chen Chen Yu-Chen Chen 1Hong Zhang Hong Zhang 2Liwei Wang Liwei Wang 1*Xindao Yin Xindao Yin 1*
  • 1 Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
  • 2 Department of Radiology, The Affiliated Jiangning Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    The primary objective was to investigate the value of the FLAIR signal intensity ratio (SIR) in identifying stroke within 4.5 hours. The secondary objective was to ascertain whether large vessel occlusion (LVO) mediated the relationship between the SIR and stroke within 4.5 hours.We analyzed 633 acute stroke patients within 24 hours of clear symptom onset. The SIR and DWI-FLAIR mismatch were evaluated. First, we determined whether demographic variables, vascular risk factors and LVO were related to stroke within 4.5 hours with multivariate logistic regression analyses and stratified regression analysis. Next, we used mediation analysis to determine whether LVO explained the association between SIR and stroke within 4.5 hours. Finally, we used receiver operating characteristic (ROC) analysis to assess the value of SIR, independent variable, and multiparameter models in identifying stroke within 4.5 hours and compared with DWI-FLAIR mismatch.Results: Hyperlipemia, LVO and SIR were associated with stroke within 4.5 hours.Mediation analysis revealed that LVO partially mediated the relationship between SIR and stroke within 4.5 hours (P < 0.001). The multiparameter model (hyperlipemia, LVO and SIR) showed significantly improved performance (AUC 0.869) in identifying stroke within 4.5 hours over DWI-FLAIR mismatch (0.684), hyperlipemia (0.632), LVO (0.667) and SIR (0.773) models.SIR is associated with stroke within 4.5 hours, and LVO partially mediates this relationship. A multiparameter model combining hyperlipemia, LVO and SIR can more accurately identify stroke within 4.5 hours than individual parameter models.

    Keywords: Stroke, Diffusion-weighted imaging, Fluid attenuated inversion recovery, onset time, Signal-intensity ratio

    Received: 06 Jun 2024; Accepted: 24 Sep 2024.

    Copyright: © 2024 Wang, Mao, Jiang, Peng, Chen, Zhang, Wang and Yin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Qianqian Mao, Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
    Mingyang Peng, Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
    Liwei Wang, Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
    Xindao Yin, Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.