Dataset Information

Multimodal magnetic resonance imaging to identify stroke onset within 6?h in patients with large vessel occlusions.

ABSTRACT:

Introduction

Mechanical thrombectomy within 6?h after stroke onset improves the outcome in patients with large vessel occlusions. The aim of our study was to establish a model based on diffusion weighted and perfusion weighted imaging to provide an accurate prediction for the 6?h time-window in patients with unknown time of stroke onset.

Patients and methods

A predictive model was designed based on data from the DEFUSE 2 study and validated in a subgroup of patients with large vessel occlusions from the AXIS 2 trial.

Results

We constructed the model in 91 patients from DEFUSE 2. The following parameters were independently associated with <6?h time-window and included in the model: interquartile range and median relative diffusion weighted imaging, hypoperfusion intensity ratio, core volume and the interaction between median relative diffusion weighted imaging and hypoperfusion intensity ratio as predictors of the 6?h time-window. The area under the curve was 0.80 with a positive predictive value of 0.90 (95%CI 0.79-0.96). In the validation cohort (N?=?90), the area under the curve was 0.73 (P for difference?=?0.4) with a positive predictive value of 0.85 (95%CI 0.69-0.95).

Discussion

After validation in a larger independent dataset the model can be considered to select patients for endovascular treatment in whom stroke onset is unknown.

Conclusion

In patients with large vessel occlusion and unknown time of stroke onset an automated multivariate imaging model is able to select patients who are likely within the 6?h time-window.

SUBMITTER: Wouters A

PROVIDER: S-EPMC6460412 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Publications

Multimodal magnetic resonance imaging to identify stroke onset within 6 h in patients with large vessel occlusions.

Wouters Anke A Dupont Patrick P Christensen Soren S Norrving Bo B Laage Rico R Thomalla Götz G Kemp Stephanie S Lansberg Maarten M Thijs Vincent V Albers Gregory W GW Lemmens Robin R

European stroke journal 20180201 2

<h4>Introduction</h4>Mechanical thrombectomy within 6 h after stroke onset improves the outcome in patients with large vessel occlusions. The aim of our study was to establish a model based on diffusion weighted and perfusion weighted imaging to provide an accurate prediction for the 6 h time-window in patients with unknown time of stroke onset.<h4>Patients and methods</h4>A predictive model was designed based on data from the DEFUSE 2 study and validated in a subgroup of patients with large ves ...[more]

PMID: 31008349

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Project description:Background and Purpose- Accurate and rapid detection of anterior circulation large vessel occlusion (LVO) is of paramount importance in patients with acute stroke due to the potentially rapid infarction of at-risk tissue and the limited therapeutic window for endovascular clot retrieval. Hence, the optimal threshold of a new, fully automated software-based approach for LVO detection was determined, and its diagnostic performance evaluated in a large cohort study. Methods- For this retrospective study, data were pooled from: 2 stroke trials, DEFUSE 2 (n=62; 07/08-09/11) and DEFUSE 3 (n=213; 05/17-05/18); a cohort of endovascular clot retrieval candidates (n=82; August 2, 2014-August 30, 2015) and normals (n=111; June 6, 2017-January 28, 2019) from a single quaternary center; and code stroke patients (n=501; January 1, 2017-December 31, 2018) from a single regional hospital. All CTAs were assessed by the automated algorithm. Consensus reads by 2 neuroradiologists served as the reference standard. ROC analysis was used to assess diagnostic performance of the algorithm for detection of (1) anterior circulation LVOs involving the intracranial internal carotid artery or M1 segment middle cerebral artery (M1-MCA); (2) anterior circulation LVOs and proximal M2 segment MCA (M2-MCA) occlusions; and (3) individual segment occlusions. Results- CTAs from 926 patients (median age 70 years, interquartile range: 58-80; 422 females) were analyzed. Three hundred ninety-five patients had an anterior circulation LVO or M2-MCA occlusion (National Institutes of Health Stroke Scale 14 [median], interquartile range: 9-19). Sensitivity and specificity were 97% and 74%, respectively, for LVO detection, and 95% and 79%, respectively, when M2 occlusions were included. On analysis by occlusion site, sensitivities were 90% (M2-MCA), 97% (M1-MCA), and 97% (intracranial internal carotid artery) with corresponding area-under-the-ROC-curves of 0.874 (M2), 0.962 (M1), and 0.997 (intracranial internal carotid artery). Conclusions- Intracranial anterior circulation LVOs and proximal M2 occlusions can be rapidly and reliably detected by an automated detection tool, which may facilitate intra- and inter-instutional workflows and emergent imaging triage in the care of patients with stroke.

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