Simplified Assessment of Lesion Water Uptake for Identification of Patients within 4.5 Hours of Stroke Onset: An Analysis of the MissPerfeCT Study
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Background and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
Abstract
Background and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
참고문헌 (14)
- Emberson J, "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials", Lancet, 384, pp.1929~1935 (2014)
- Fink JN, "The stroke patient who woke up: clinical and radiological features, including diffusion and perfusion MRI", Stroke, 33, pp.988~993 (2002)
- Ma H, "Thrombolysis guided by perfusion imaging up to 9hours after onset of stroke", N Engl J Med, 380, pp.1795~1803 (2019)
- Thomalla G, "MRI-guided thrombolysis for stroke with unknown time of onset", N Engl J Med, 379, pp.611~622 (2018)
- Scheldeman L, "Different mismatch concepts for magnetic resonance imaging-guided thrombolysis in unknown onset stroke", Ann Neurol, 87, pp.931~938 (2020)
- Minnerup J, "Computed tomography-based quantification of lesion water uptake identifies patients within 4.5hours of stroke onset: a multicenter observational study", Ann Neurol, 80, pp.924~934 (2016)
- Kemmling A, "Multivariate dynamic prediction of ischemic infarction and tissue salvage as a function of time and degree of recanalization", J Cereb Blood Flow Metab, 35, pp.1397~1405 (2015)
- Thomalla G, "DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4·5 h of symptom onset (PRE-FLAIR): a multicentre observational study", Lancet Neurol, 10, pp.978~986 (2011)
- Breuer L, "Feasibility and safety of magnetic resonance imaging-based thrombolysis in patients with stroke on awakening : initial single-centre experience", Int J Stroke, 5, pp.68~73 (2010)
- Aoki J, "Intravenous thrombolysis based on diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch in acute stroke patients with unknown onset time", Cerebrovasc Dis, 31, pp.435~441 (2011)
- Dzialowski I, "Brain tissue water uptake after middle cerebral artery occlusion assessed with CT", J Neuroimaging, 14, pp.42~48 (2004)
- Campbell BC, "Extending thrombolysis to 4·5-9 h and wakeup stroke using perfusion imaging : a systematic review and meta-analysis of individual patient data", Lancet, 394, pp.139~147 (2019)
- Broocks G, "Lesion age imaging in acute stroke : water uptake in CT versus DWI-FLAIR mismatch", Ann Neurol, 88, pp.1144~1152 (2020)
- Psychogios MN, "visual scoring of collaterals and CBV-ASPECTS : has the machine surpassed the eye", Clin Neuroradiol, 31, pp.499~506 (2021)