Diffusion-Weighted Imaging, MR Angiography, and Baseline Data in a Systematic Multicenter Analysis of 3,301 MRI Scans of Ischemic Stroke Patients-Neuroradiological Review Within the MRI-GENIE Study

Mattias Drake; Petrea Frid; Björn M Hansen; Ona Wu; Anne-Katrin Giese; Markus D Schirmer; Kathleen Donahue; Lisa Cloonan; Robert E Irie; Mark J R J Bouts; Elissa C McIntosh; Steven J T Mocking; Adrian V Dalca; Ramesh Sridharan; Huichun Xu; Eva Giralt-Steinhauer; Lukas Holmegaard; Katarina Jood; Jaume Roquer; John W Cole; Patrick F McArdle; Joseph P Broderick; Jordi Jiménez-Conde; Christina Jern; Brett M Kissela; Dawn O Kleindorfer; Robin Lemmens; James F Meschia; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Vincent Thijs; Daniel Woo; Bradford B Worrall; Steven J Kittner; Braxton D Mitchell; Jonathan Rosand; Polina Golland; Arne Lindgren; Natalia S Rost; Johan Wassélius

doi:10.3389/fneur.2020.00577

Diffusion-Weighted Imaging, MR Angiography, and Baseline Data in a Systematic Multicenter Analysis of 3,301 MRI Scans of Ischemic Stroke Patients-Neuroradiological Review Within the MRI-GENIE Study

Front Neurol. 2020 Jun 25:11:577. doi: 10.3389/fneur.2020.00577. eCollection 2020.

Authors

Mattias Drake^{1

2}, Petrea Frid^{3

4}, Björn M Hansen^{1

2}, Ona Wu⁵, Anne-Katrin Giese^{6

7}, Markus D Schirmer^{6

8}, Kathleen Donahue⁶, Lisa Cloonan⁶, Robert E Irie⁵, Mark J R J Bouts⁵, Elissa C McIntosh⁵, Steven J T Mocking⁵, Adrian V Dalca^{5

9}, Ramesh Sridharan⁹, Huichun Xu¹⁰, Eva Giralt-Steinhauer¹¹, Lukas Holmegaard¹², Katarina Jood¹², Jaume Roquer¹¹, John W Cole¹³, Patrick F McArdle¹⁰, Joseph P Broderick¹⁴, Jordi Jiménez-Conde¹¹, Christina Jern¹⁵, Brett M Kissela¹⁴, Dawn O Kleindorfer¹⁴, Robin Lemmens^{16

17}, James F Meschia¹⁸, Tatjana Rundek¹⁹, Ralph L Sacco¹⁹, Reinhold Schmidt²⁰, Pankaj Sharma^{21

22}, Agnieszka Slowik²³, Vincent Thijs^{24

25}, Daniel Woo¹⁴, Bradford B Worrall²⁶, Steven J Kittner¹³, Braxton D Mitchell^{10

27}, Jonathan Rosand^{5

6

28}, Polina Golland⁹, Arne Lindgren^{3

29}, Natalia S Rost⁶, Johan Wassélius^{1

2}

Affiliations

¹ Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
² Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden.
³ Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
⁴ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden.
⁵ Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States.
⁶ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
⁷ Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, United States.
⁸ Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
⁹ Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States.
¹⁰ Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
¹¹ Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), University at Autonoma de Barcelona, Barcelona, Spain.
¹² Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹³ Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, United States.
¹⁴ Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
¹⁵ Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁶ Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium.
¹⁷ Department of Neurology, VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Leuven, Belgium.
¹⁸ Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
¹⁹ Department of Neurology and the Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States.
²⁰ Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria.
²¹ Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, United Kingdom.
²² Ashford and St Peter's Hospital, Surrey, United Kingdom.
²³ Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
²⁴ Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
²⁵ Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
²⁶ Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
²⁷ Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, United States.
²⁸ Henry and Allison McCancer Center for Brain Health and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
²⁹ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden.

Abstract

Background: Magnetic resonance imaging (MRI) serves as a cornerstone in defining stroke phenotype and etiological subtype through examination of ischemic stroke lesion appearance and is therefore an essential tool in linking genetic traits and stroke. Building on baseline MRI examinations from the centralized and structured radiological assessments of ischemic stroke patients in the Stroke Genetics Network, the results of the MRI-Genetics Interface Exploration (MRI-GENIE) study are described in this work. Methods: The MRI-GENIE study included patients with symptoms caused by ischemic stroke (N = 3,301) from 12 international centers. We established and used a structured reporting protocol for all assessments. Two neuroradiologists, using a blinded evaluation protocol, independently reviewed the baseline diffusion-weighted images (DWIs) and magnetic resonance angiography images to determine acute lesion and vascular occlusion characteristics. Results: In this systematic multicenter radiological analysis of clinical MRI from 3,301 acute ischemic stroke patients according to a structured prespecified protocol, we identified that anterior circulation infarcts were most prevalent (67.4%), that infarcts in the middle cerebral artery (MCA) territory were the most common, and that the majority of large artery occlusions 0 to 48 h from ictus were in the MCA territory. Multiple acute lesions in one or several vascular territories were common (11%). Of 2,238 patients with unilateral DWI lesions, 52.6% had left-sided infarct lateralization (P = 0.013 for χ² test). Conclusions: This large-scale analysis of a multicenter MRI-based cohort of AIS patients presents a unique imaging framework facilitating the relationship between imaging and genetics for advancing the knowledge of genetic traits linked to ischemic stroke.

Keywords: DWI; MRI; imaging; phenotype; stroke.

Copyright © 2020 Drake, Frid, Hansen, Wu, Giese, Schirmer, Donahue, Cloonan, Irie, Bouts, McIntosh, Mocking, Dalca, Sridharan, Xu, Giralt-Steinhauer, Holmegaard, Jood, Roquer, Cole, McArdle, Broderick, Jiménez-Conde, Jern, Kissela, Kleindorfer, Lemmens, Meschia, Rundek, Sacco, Schmidt, Sharma, Slowik, Thijs, Woo, Worrall, Kittner, Mitchell, Rosand, Golland, Lindgren, Rost and Wassélius.