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

Autor:	Sporns PB; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany., Kemmling A; Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany.; Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.; Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany., Meyer L; Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany., Krogias C; Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany., Puetz V; Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany., Thierfelder KM; Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany., Duering M; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland.; Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany., Lukas C; Department of Neuroradiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany., Kaiser D; Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany., Langner S; Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany., Brehm A; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland., Rotkopf LT; Department of Radiology, German Cancer Research Center, Heidelberg, Germany., Kunz WG; Department of Radiology, University Hospital, LMU Munich, Germany., Beuker C; Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany., Heindel W; Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany., Fiehler J; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Schramm P; Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany., Wiendl H; Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany., Minnerup H; Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany., Psychogios MN; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland., Minnerup J; Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2023 Dec 29; Vol. 14, pp. 1320620. Date of Electronic Publication: 2023 Dec 29 (Print Publication: 2023).
DOI:	10.3389/fneur.2023.1320620
Abstrakt:	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). Competing Interests: JM has received grants from Deutsche Forschungsgemeinschaft, Bundesministerium für Bildung und Forschung (BMBF), Else KrönerFresenius-Stiftung, EVER Pharma Jena GmbH, and Ferrer International, travel grants from Boehringer Ingelheim, and speaking fees from Bayer Vital and Chugai Pharma. MD has received honoraria for lectures from Bayer Vital and Sanofi Genzyme. Consultant for Hovid Berhad and Roche Pharma. CL received consulting and speaker’s honoraria from Biogen Idec, Bayer Schering, Bristol-Myers Squibb, Daiichi Sanykyo, Merck Serono, Novartis, Sanofi, Genzyme and TEVA. JF has received grants from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker. Consultant for: Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Microvention, Penumbra, Phenox, Stryker, Transverse Medical. Stock holder: Tegus Medical. CK has received honoraria and travel grants from Bayer Vital and Daiichi-Sankyo. DK receives a grant from Else Kröner-Fresenius-Center for Digital Health. PS has received grants from Siemens and Penumbra. Consultant for: Penumbra, Phenox, Stryker, Cerus endovascular. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. (Copyright © 2023 Sporns, Kemmling, Meyer, Krogias, Puetz, Thierfelder, Duering, Lukas, Kaiser, Langner, Brehm, Rotkopf, Kunz, Beuker, Heindel, Fiehler, Schramm, Wiendl, Minnerup, Psychogios and Minnerup.)
Databáze:	MEDLINE
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