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Delayed Lesions on Diffusion-Weighted Imaging in Initially Lesion-Negative Stroke Patients

Journal of Stroke 2021년 23권 1호 p.69 ~ 81
김기태, 김범준, 허재원, 양성규, 양미화, 한문구, 정철규, 최병세, 김재형, 배희준,
소속 상세정보
김기태 ( Kim Ki-Tae ) - Seoul National University Bundang Hospital Department of Neurology
김범준 ( Kim Beom-Joon ) - Seoul National University Bundang Hospital Department of Neurology
허재원 ( Huh Jae-Won ) - UT Southwestern Medical Center Lyda Hill Department of Bioinformatics
양성규 ( Yang Seong-Kyu ) - Seoul National University Bundang Hospital Department of Neurology
양미화 ( Yang Mi-Hwa ) - Seoul National University Bundang Hospital Department of Neurology
한문구 ( Han Moon-Ku ) - Seoul National University Bundang Hospital Department of Neurology
정철규 ( Jung Cheol-Kyu ) - Seoul National University Bundang Hospital Department of Radiology
최병세 ( Choi Byung-Se ) - Seoul National University Bundang Hospital Department of Radiology
김재형 ( Kim Jae-Hyoung ) - Seoul National University Bundang Hospital Department of Radiology
배희준 ( Bae Hee-Joon ) - Seoul National University Bundang Hospital Department of Neurology

Abstract


Background and Purpose: Lesions on diffusion-weighted imaging (DWI) occasionally appear on follow-up magnetic resonance imaging (MRI) among initially DWI-negative but clinically suspicious stroke patients. We established the prevalence of positive conversion in DWI-negative stroke and determined the clinical factors associated with it.

Methods: This retrospective, observational, single-center study included 5,271 patients hospitalized due to stroke/transient ischemic attack (TIA) in a single university hospital during 2010 to 2017. Patients without initial DWI lesions underwent follow-up DWI imaging as a routine practice. Adjusted hazard ratios (aHRs) for recurrent stroke risk according to positive conversion were determined using Cox proportional hazard regression. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for positive conversion among initially DWI-negative patients were estimated.

Results: In total, 694 (13.2%) patients (mean±standard deviation age, 62.9±13.7 years; male, 404 [58.2%]) were initially DWI-negative. Among them, 22.5% had positive-conversion on follow-up DWI. Positive conversion was associated with a higher risk of recurrent stroke (aHR, 3.12; 95% CI, 1.56 to 6.26). Early neurologic deterioration (aOR, 15.1; 95% CI, 5.71 to 47.66), atrial fibrillation (aOR, 6.17; 95% CI, 3.23 to 12.01), smoking (aOR, 3.76; 95% CI, 2.19 to 6.63), pre-stroke dependency (aOR, 1.62; 95% CI, 1.15 to 2.27), objective hemiparesis (aOR, 4.39; 95% CI, 1.90 to 10.32), longer symptom duration (aOR, 2.17; 95% CI, 1.57 to 3.08), high cholesterol (aOR, 4.70; 95% CI, 1.78 to 12.77), National Institutes of Health Stroke Scale score (aOR, 1.44; 95% CI, 1.08 to 1.91), and high systolic blood pressure (aOR, 1.01; 95% CI, 1.00 to 1.02) were associated with a higher incidence of lesions with delayed appearance. Regarding the location of lesions on follow-up DWI, 34.6% and 21.2% were in the cortex and brainstem, respectively.

Conclusions: In DWI-negative stroke/TIA, positive conversion is associated with a higher risk of recurrent stroke. DWI-negative stroke with factors related to positive conversion may require follow-up MRI for a definitive diagnosis.

키워드

Stroke; Diffusion magnetic resonance imaging; DWI-negative stroke; Delayed DWI lesion

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