Clinical significance of acute and chronic ischaemic lesions in multiple cerebral vascular territories

Objectives To investigate the association between acute and chronic ischaemic lesions in a multiple territory lesion pattern (MTLP) detected by 3-Tesla MRI and stroke aetiology, specifically atrial fibrillation-associated stroke. Methods We analysed data from the 1000+ study – a prospective, observational 3-Tesla MRI cohort study of consecutively included acute stroke patients. Acute and chronic lesions were detected by DWI and fluid-attenuated inversion recovery, respectively. Observers blinded to clinical data allocated lesions to the right anterior, left anterior or posterior circulation. Lesion pattern was categorised as MTLP a/c when more than one territory was affected by either acute or chronic lesions or as MTLP a when more than one territory was affected by acute lesions alone. Results Of the 1,000 included patients, an MTLP a/c was found in 43% and MTLP a in 24%. Advanced age (aOR=1.21 per 10 years, 95% CI 1.06–1.39), atrial fibrillation (aOR=1.44, 95% CI 1.06–1.94), aortic arch atherosclerosis (aOR=2.52, 95% CI 1.10–5.77), malignant disease (aOR=1.99, 95% CI 1.25–3.16) and lower estimated glomerular filtration rate (eGFR) (aOR=0.90 per 10 ml, 95% CI 0.84–0.97) were associated with MTLP a/c . Only malignant disease (aOR=2.03, 95% CI 1.27–3.23) and lower eGFR (aOR=0.91 per 10 ml, 95% CI 0.85–0.97) were associated with MTLP a . Conclusions An MRI-detected multiple territory lesion pattern of acute and chronic ischaemic lesions is frequent and more often present in older patients and patients with atrial fibrillation, aortic arch atherosclerosis, malignant disease and lower eGFR. Considering not only acute but also chronic ischaemic lesions may facilitate identifying atrial fibrillation-associated or aorto-embolic stroke. Key Points • Brain imaging with MRI may help to determine the aetiology of stroke. • Of 1,000 stroke patients undergoing 3-Tesla MRI, 43% had acute and chronic ischaemic lesions in multiple cerebral vascular territories. • Atrial fibrillation, aortic arch atherosclerosis and malignant disease were associated with a multiple territory lesion pattern.