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Original Contribution
December 2006

Silent Ischemic Lesion Recurrence on Magnetic Resonance Imaging Predicts Subsequent Clinical Vascular Events

Author Affiliations

Author Affiliations: Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Md (Drs Kang, Latour, and Warach and Ms Lattimore); and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Dr Kang).

Arch Neurol. 2006;63(12):1730-1733. doi:10.1001/archneur.63.12.1730

Background  Previous studies identified a high frequency of silent ischemic lesion recurrence on magnetic resonance imaging (MRI) after an index stroke.

Objective  To investigate whether ischemic lesion recurrence on MRI predicts subsequent clinical events.

Design  Retrospective cohort study.

Setting  General community hospital.

Patients  We recruited 120 patients who experienced an acute ischemic stroke (IS) and who underwent initial MRI within 24 hours of onset and subsequent MRI on day 5. Of those patients, 68 underwent follow-up MRI up to 90 days after onset.

Main Outcome Measures  Early silent lesion recurrence was defined as new asymptomatic ischemic lesions on 5-day MRI, and late silent lesion recurrence was defined as those on 30- or 90-day MRI. Patients were followed up for recurrent vascular events by interviews.

Results  Among the 104 patients (86.7%) who had available clinical outcome data, 35 (33.7%) had early silent lesion recurrence; 15 (22.1%) of 68 patients had late silent lesion recurrence. Of the patients, 8 experienced a recurrent IS, 3 experienced a transient ischemic attack, and 3 had vascular deaths during a mean ± SD follow-up of 19.3 ± 9.0 months. For recurrent IS as a clinical end point, late silent lesion recurrence independently predicted recurrent IS (odds ratio, 6.55; 95% confidence interval, 1.09-39.55) by the Cox proportional hazards model. For combined clinical end points, early (odds ratio, 3.19; 95% confidence interval, 1.02-10.00) and late (odds ratio, 8.09; 95% confidence interval, 1.29-50.91) silent lesion recurrences independently predicted clinical recurrent IS, transient ischemic attack, or vascular deaths.

Conclusion  These data suggest that silent ischemic lesion recurrence on MRI may be a potential surrogate marker of clinical recurrence.