Clinical-Radiological Parameters Improve the Prediction of the Thrombolysis Time Window by Both MRI Signal Intensities and DWI-FLAIR Mismatch
| Autor: | Jan Sobesky, Martin Ebinger, Sophie K. Piper, Wolf-Dieter Heiss, Ulrike Grittner, Carla N. Wood, Federico C. von Samson-Himmelstjerna, Gajanan S. Revankar, Vince I. Madai, Steve Z. Martin, Jochen B. Fiebach, Ivana Galinovic, Olivier Zaro-Weber, Walter Moeller-Hartmann |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Fluid-attenuated inversion recovery 030218 nuclear medicine & medical imaging 0302 clinical medicine Germany Medicine Thrombolytic Therapy Stroke Neuroradiology Aged 80 and over medicine.diagnostic_test Thrombolysis Middle Aged Neurology Predictive value of tests Area Under Curve Cerebrovascular Circulation Female Radiology Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Clinical Decision-Making Drug Administration Schedule Time-to-Treatment 03 medical and health sciences Fibrinolytic Agents Predictive Value of Tests Image Interpretation Computer-Assisted Humans cardiovascular diseases Aged Retrospective Studies Chi-Square Distribution business.industry Patient Selection Magnetic resonance imaging medicine.disease Diffusion Magnetic Resonance Imaging Logistic Models ROC Curve Multivariate Analysis Neurology (clinical) business Nuclear medicine 030217 neurology & neurosurgery Fibrinolytic agent Diffusion MRI |
| Zdroj: | Cerebrovascular diseases (Basel, Switzerland). 42(1-2) |
| ISSN: | 1421-9786 |
| Popis: | Background: With regard to acute stroke, patients with unknown time from stroke onset are not eligible for thrombolysis. Quantitative diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) MRI relative signal intensity (rSI) biomarkers have been introduced to predict eligibility for thrombolysis, but have shown heterogeneous results in the past. In the present work, we investigated whether the inclusion of easily obtainable clinical-radiological parameters would improve the prediction of the thrombolysis time window by rSIs and compared their performance to the visual DWI-FLAIR mismatch. Methods: In a retrospective study, patients from 2 centers with proven stroke with onset Results: In 82 patients, the unadjusted rSI measures DWI-mean and -SD showed the highest AUCs (AUC 0.86-0.87). Adjustment for clinical-radiological covariates significantly improved the performance of FLAIR-mean (0.91) and DWI-SD (0.91). The best prediction results based on the AUC were found for the final stratified and adjusted models of DWI-SD (0.94) and FLAIR-mean (0.96) and a multivariable DWI-FLAIR model (0.95). The adjusted visual DWI-FLAIR mismatch did not perform in a significantly worse manner (0.89). ADC-rSIs showed fair performance in all models. Conclusions: Quantitative DWI and FLAIR MRI biomarkers as well as the visual DWI-FLAIR mismatch provide excellent prediction of eligibility for thrombolysis in acute stroke, when easily obtainable clinical-radiological parameters are included in the prediction models. |
| Databáze: | OpenAIRE |
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