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

Anke Wouters, Patrick Dupont, Soren Christensen, Bo Norrving, Rico Laage, Götz Thomalla, Stephanie Kemp, Maarten Lansberg, Vincent Thijs, Gregory W. Albers, Robin Lemmens

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)

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.

Original languageEnglish
Pages (from-to)185-192
Number of pages8
JournalEuropean Stroke Journal
Volume3
Issue number2
DOIs
Publication statusPublished - 2018

Subject classification (UKÄ)

  • Neurology

Keywords

  • Acute stroke therapy
  • cerebral infarction
  • ischaemic stroke
  • magnetic resonance imaging
  • stroke
  • thrombectomy
  • treatment
  • unknown onset

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