{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:13:11Z","timestamp":1790161991615,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"abstract":"\n Objective<\/jats:title>\n On non\u2010contrast computed tomography (NCCT), progressive hypoattenuation can be quantified as percent net water uptake (%NWU), whereas relative fluid attenuated inversion recovery (rFLAIR)\u2010magnetic resonance imaging hyperintensity marks later\u2010stage vasogenic edema and blood\u2013brain\u2010barrier disruption. We compared the degree and rate of %NWU versus rFLAIR development and characterized 4 ischemic edema imaging profiles relative to a magnetic resonance (MR)\u2010diffusion\u2010weighted\u2010imaging (MR\u2010DWI) reference standard.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n NCCT and fluid attenuated inversion recovery (FLAIR) images from MR\u2010DWI\u2010positive hyperacute stroke patients were visually rated positive (+) or negative (\u2212) for ischemic hypodensity\/hyperintensity and sulcal\u2010effacement (SE), defining 4 edema imaging profiles: (I) NWU\u2212\/FLAIR\u2212\/SE\u2212, (II) NWU+\/FLAIR\u2212\/SE\u2212, (III) NWU+\/FLAIR+\/SE\u2212, and (IV) NWU+\/FLAIR+\/SE+. %NWU, rFLAIR, and relative apparent diffusion coefficient (rADC) were quantified within the DWI\/apparent diffusion coefficient\u2010defined core region\u2010of\u2010interest, normalized to the contralateral mirror region, and compared between groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 53 DWI+ patients, n\u2009=\u20095\/17\/13\/17 were in groups I to IV, with mean onset\u2010to\u2010CT times of 2.4\u2009\u00b1\u20091.2\/2.5\u2009\u00b1\u20091.6\/3.2\u2009\u00b1\u20091.9\/5.0\u2009\u00b1\u20091.6\u2009hours (\n p<\/jats:italic>\n \u2009<\u20090.01), and baseline characteristics were comparable (all\n p<\/jats:italic>\n \u2009\u2265\u20090.12). Mean %NWU differed between all groups (1.4\u2009\u00b1\u20090.3\/4.3\u2009\u00b1\u20094.2\/8.0\u2009\u00b1\u20094.1\/13.6\u2009\u00b1\u20094.3; all pairwise\n p<\/jats:italic>\n \u2009<\u20090.012), rADC did not (\n p<\/jats:italic>\n \u2009=\u20090.21), and rFLAIR differed only between groups II and III versus group IV (\n p<\/jats:italic>\n \u2009=\u20090.02,\n p<\/jats:italic>\n \u2009=\u20090.04). %NWU and rFLAIR were uncorrelated (\n R<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.02,\n p<\/jats:italic>\n \u2009=\u20090.48). Fitted %NWU increased monotonically and near\u2010linearly within 4.5\u2009hours post\u2010ictus, whereas rFLAIR rose abruptly only in the late transition to group IV.\n <\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n Quantitative %NWU\u2010CT was more sensitive than rFLAIR for detecting the earliest edematous stages of hyperacute stroke, discriminating early, intermediate, late, and late\u2010severe (SE) stages; rFLAIR increased only in the latest stage. %NWU may, therefore, provide a practical, quantitative CT marker of edema progression, supporting acute triage and risk phenotyping in CT\u2010first pathways, pending prospective validation. ANN NEUROL 2026<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ana.78369","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:34:54Z","timestamp":1790159694000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sensitivity of Non\u2010contrast\n Computed Tomography<\/scp>\n Net Water Uptake Versus\n FLAIR<\/scp>\n \u2010\n MRI<\/scp>\n , with\n MR<\/scp>\n \u2010\n DWI<\/scp>\n Reference Standard, for Early Detection and Physiological Characterization of Ischemic Edema in Hyperacute Stroke"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7575-9850","authenticated-orcid":false,"given":"Gabriel","family":"Broocks","sequence":"first","affiliation":[{"name":"Department of Neuroradiology HELIOS Medical Center, University Campus of MSH Medical School Hamburg Schwerin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Kemmling","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology University Hospital Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Werner","sequence":"additional","affiliation":[{"name":"Image Processing and Medical Imaging (IPMI) Institute for Applied Medical Informatics, Institute for Computational Neuroscience, University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Sentker","sequence":"additional","affiliation":[{"name":"Image Processing and Medical Imaging (IPMI) Institute for Applied Medical Informatics, Institute for Computational Neuroscience, University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Regenhardt","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Department of Neurosurgery Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-2020","authenticated-orcid":false,"given":"Tobias","family":"Faizy","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology University Hospital Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Kam","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Department of Radiology Alfred Health, Central Clinical School, Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-2370","authenticated-orcid":false,"given":"Helge","family":"Kniep","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-638X","authenticated-orcid":false,"given":"Lukas","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Alfke","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology HELIOS Medical Center, University Campus of MSH Medical School Hamburg Schwerin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Lev","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJMoa1804355","article-title":"MRI\u2010guided 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