{"doi":"10.1002/ana.26954","title":"Diffusion‐Weighted Imaging Fluid‐Attenuated Inversion Recovery Mismatch on Portable, Low‐Field Magnetic Resonance Imaging Among Acute Stroke Patients","abstract":"OBJECTIVE: For stroke patients with unknown time of onset, mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) can guide thrombolytic intervention. However, access to MRI for hyperacute stroke is limited. Here, we sought to evaluate whether a portable, low-field (LF)-MRI scanner can identify DWI-FLAIR mismatch in acute ischemic stroke. METHODS: Eligible patients with a diagnosis of acute ischemic stroke underwent LF-MRI acquisition on a 0.064-T scanner within 24 h of last known well. Qualitative and quantitative metrics were evaluated. Two trained assessors determined the visibility of stroke lesions on LF-FLAIR. An image coregistration pipeline was developed, and the LF-FLAIR signal intensity ratio (SIR) was derived. RESULTS: The study included 71 patients aged 71 ± 14 years and a National Institutes of Health Stroke Scale of 6 (interquartile range 3-14). The interobserver agreement for identifying visible FLAIR hyperintensities was high (κ = 0.85, 95% CI 0.70-0.99). Visual DWI-FLAIR mismatch had a 60% sensitivity and 82% specificity for stroke patients <4.5 h, with a negative predictive value of 93%. LF-FLAIR SIR had a mean value of 1.18 ± 0.18 <4.5 h, 1.24 ± 0.39 4.5-6 h, and 1.40 ± 0.23 >6 h of stroke onset. The optimal cut-point for LF-FLAIR SIR was 1.15, with 85% sensitivity and 70% specificity. A cut-point of 6.6 h was established for a FLAIR SIR <1.15, with an 89% sensitivity and 62% specificity. INTERPRETATION: A 0.064-T portable LF-MRI can identify DWI-FLAIR mismatch among patients with acute ischemic stroke. Future research is needed to prospectively validate thresholds and evaluate a role of LF-MRI in guiding thrombolysis among stroke patients with uncertain time of onset. ANN NEUROL 2024;96:321-331.","journal":"Annals of Neurology","year":2024,"id":427332,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9595,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1161649,"name":"Jennifer D. Guo","orcid":"0009-0003-8438-2826","position":1,"is_corresponding":false},{"id":421725,"name":"Adam de Havenon","orcid":"0000-0001-8178-8597","position":2,"is_corresponding":false},{"id":549917,"name":"Seyedmehdi Payabvash","orcid":"0000-0003-4628-0370","position":3,"is_corresponding":false},{"id":623213,"name":"Gordon Sze","orcid":"0000-0002-1143-8556","position":4,"is_corresponding":false},{"id":748349,"name":"Nándor Pintér","orcid":"0000-0002-7714-143X","position":5,"is_corresponding":false},{"id":1227481,"name":"Vinay Jaikumar","orcid":"0000-0002-6677-1858","position":6,"is_corresponding":false},{"id":333751,"name":"Adnan H. Siddiqui","orcid":"0000-0002-9519-0059","position":7,"is_corresponding":false},{"id":774184,"name":"Steven N. Baldassano","orcid":"0000-0002-0291-1567","position":8,"is_corresponding":false},{"id":1228004,"name":"Ana‐Lucia Garcia‐Guarniz","orcid":null,"position":9,"is_corresponding":false},{"id":1043359,"name":"Julia Zabinska","orcid":null,"position":10,"is_corresponding":false},{"id":1043358,"name":"Dheeraj Lalwani","orcid":null,"position":11,"is_corresponding":false},{"id":1228005,"name":"Emma Peasley","orcid":null,"position":12,"is_corresponding":false},{"id":256551,"name":"Joshua N. Goldstein","orcid":"0000-0002-6406-1828","position":13,"is_corresponding":false},{"id":1227482,"name":"Olivia Nelson","orcid":"0000-0002-2930-138X","position":14,"is_corresponding":false},{"id":307822,"name":"Pamela W. Schaefer","orcid":"0000-0002-4222-6134","position":15,"is_corresponding":false},{"id":584722,"name":"Charles Wira","orcid":"0000-0002-1041-4165","position":16,"is_corresponding":false},{"id":866751,"name":"John Pitts","orcid":null,"position":17,"is_corresponding":false},{"id":474606,"name":"Vivien Lee","orcid":"0000-0002-8615-198X","position":18,"is_corresponding":false},{"id":249930,"name":"Keith W. Muir","orcid":"0000-0001-9535-022X","position":19,"is_corresponding":false},{"id":496114,"name":"Shahid M. Nimjee","orcid":"0000-0002-0317-8731","position":20,"is_corresponding":false},{"id":307821,"name":"John E. Kirsch","orcid":"0000-0002-0389-9475","position":21,"is_corresponding":false},{"id":242311,"name":"Juan Eugenio Iglesias","orcid":"0000-0001-7569-173X","position":22,"is_corresponding":false},{"id":241416,"name":"Matthew S. Rosen","orcid":"0000-0002-7194-002X","position":23,"is_corresponding":false},{"id":256547,"name":"Kevin N. Sheth","orcid":"0000-0003-2003-5473","position":24,"is_corresponding":false},{"id":350022,"name":"W. Taylor Kimberly","orcid":"0000-0002-2519-8530","position":25,"is_corresponding":false},{"id":1018210,"name":"Annabel Sorby‐Adams","orcid":"0000-0003-1648-3898","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-19T01:58:47.805440Z","pmid":"38738750","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}