Clinically Confirmed Stroke With Negative Diffusion-Weighted Imaging Magnetic Resonance Imaging: Longitudinal Study of Clinical Outcomes, Stroke Recurrence, and Systematic Review

Stephen D. Makin, Fergus N. Doubal, Martin S. Dennis, Joanna M. Wardlaw

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year. METHODS: We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14%), symptomatic or asymptomatic, than DWI-negative patients (2%; P=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21% (95% confidence interval, 12%-32%). CONCLUSIONS: Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.
Original languageEnglish
Pages (from-to)3142-3148
Number of pages7
JournalStroke
Volume46
Issue number11
DOIs
Publication statusPublished - 29 Sep 2015

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Longitudinal Studies
Stroke
Magnetic Resonance Imaging
Recurrence
Diffusion Magnetic Resonance Imaging
Secondary Prevention
Confidence Intervals

Keywords

  • Aged Diffusion Magnetic Resonance Imaging/methods/*trends Female Follow-Up Studies Humans Longitudinal Studies Male Middle Aged Prospective Studies Recurrence Risk Factors Stroke/*diagnosis/epidemiology/*metabolism Treatment Outcome cognition diffusion ischemic attack, transient magnetic resonance imaging stroke

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Clinically Confirmed Stroke With Negative Diffusion-Weighted Imaging Magnetic Resonance Imaging : Longitudinal Study of Clinical Outcomes, Stroke Recurrence, and Systematic Review. / Makin, Stephen D.; Doubal, Fergus N.; Dennis, Martin S.; Wardlaw, Joanna M.

In: Stroke, Vol. 46, No. 11, 29.09.2015, p. 3142-3148.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND PURPOSE: We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year. METHODS: We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14{\%}), symptomatic or asymptomatic, than DWI-negative patients (2{\%}; P=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21{\%} (95{\%} confidence interval, 12{\%}-32{\%}). CONCLUSIONS: Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.",
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AU - Dennis, Martin S.

AU - Wardlaw, Joanna M.

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N2 - BACKGROUND AND PURPOSE: We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year. METHODS: We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14%), symptomatic or asymptomatic, than DWI-negative patients (2%; P=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21% (95% confidence interval, 12%-32%). CONCLUSIONS: Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.

AB - BACKGROUND AND PURPOSE: We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year. METHODS: We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14%), symptomatic or asymptomatic, than DWI-negative patients (2%; P=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21% (95% confidence interval, 12%-32%). CONCLUSIONS: Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.

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