Computed tomography hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch to identify stroke patients eligible for thrombolysis

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Peter B Sporns - , Universitätsspital Basel (Autor:in)
  • André Kemmling - , Universitätsklinikum Münster (Autor:in)
  • Lennart Meyer - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Christos Krogias - , Ruhr-Universität Bochum (Autor:in)
  • Volker Puetz - , Klinik und Poliklinik für Neurologie, Dresdner NeurovaskuläresCentrum, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • Kolja M Thierfelder - , Universitätsmedizin Rostock (Autor:in)
  • Marco Duering - , Universität Basel (Autor:in)
  • Carsten Lukas - , Ruhr-Universität Bochum (Autor:in)
  • Daniel Kaiser - , Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • Sönke Langner - , Universitätsmedizin Rostock (Autor:in)
  • Alex Brehm - , Universitätsspital Basel (Autor:in)
  • Lukas T Rotkopf - , Deutsches Krebsforschungszentrum (DKFZ) (Autor:in)
  • Wolfgang G Kunz - , University Hospital Olomouc (Autor:in)
  • Carolin Beuker - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Walter Heindel - , Universitätsklinikum Münster (Autor:in)
  • Jens Fiehler - , Universitätsklinikum Hamburg-Eppendorf (UKE) (Autor:in)
  • Peter Schramm - , Universitätsklinikum Schleswig-Holstein Campus Lübeck (Autor:in)
  • Heinz Wiendl - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Heike Minnerup - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Marios Nikos Psychogios - , Universitätsspital Basel (Autor:in)
  • Jens Minnerup - , Westfälische Wilhelms-Universität Münster (Autor:in)

Abstract

BACKGROUND AND PURPOSE: Automated perfusion imaging can detect stroke patients with unknown time of symptom onset who are eligible for thrombolysis. However, the availability of this technique is limited. We, therefore, established the novel concept of computed tomography (CT) hypoperfusion-hypodensity mismatch, i.e., an ischemic core lesion visible on cerebral perfusion CT without visible hypodensity in the corresponding native cerebral CT. We compared both methods regarding their accuracy in identifying patients suitable for thrombolysis.

METHODS: In a retrospective analysis of the MissPerfeCT observational cohort study, patients were classified as suitable or not for thrombolysis based on established time window and imaging criteria. We calculated predictive values for hypoperfusion-hypodensity mismatch and automated perfusion imaging to compare accuracy in the identification of patients suitable for thrombolysis.

RESULTS: Of 247 patients, 219 (88.7%) were eligible for thrombolysis and 28 (11.3%) were not eligible for thrombolysis. Of 197 patients who were within 4.5 h of symptom onset, 190 (96.4%) were identified by hypoperfusion-hypodensity mismatch and 88 (44.7%) by automated perfusion mismatch (p < 0.001). Of 22 patients who were beyond 4.5 h of symptom onset but were eligible for thrombolysis, 5 patients (22.7%) were identified by hypoperfusion-hypodensity mismatch. Predictive values for the hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch were as follows: sensitivity, 89.0% vs. 50.2%; specificity, 71.4% vs. 100.0%; positive predictive value, 96.1% vs. 100.0%; and negative predictive value, 45.5% vs. 20.4%.

CONCLUSION: The novel method of hypoperfusion-hypodensity mismatch can identify patients suitable for thrombolysis with higher sensitivity and lower specificity than established techniques. Using this simple method might therefore increase the proportion of patients treated with thrombolysis without the use of special automated software.The MissPerfeCT study is a retrospective observational multicenter cohort study and is registered with clinicaltrials.gov (NCT04277728).

Details

OriginalspracheEnglisch
Aufsatznummer1320620
Seitenumfang7
FachzeitschriftFrontiers in neurology
Jahrgang14
PublikationsstatusVeröffentlicht - 29 Dez. 2023
Peer-Review-StatusJa

Externe IDs

ORCID /0000-0001-5258-0025/work/150330307
PubMed 38225983
PubMedCentral PMC10788186
Scopus 85182159604

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Bibliotheksschlagworte