Prediction of long-term recurrent ischemic stroke: the added value of non-contrast CT, CT perfusion, and CT angiography

Autor: Kauw, F., Greving, J.P., Takx, R.A.P., Jong, H. de, Schonewille, W.J., Vos, J.A, Wermer, M.J., Walderveen, Marianne A.A. van, Kappelle, L.J., Meijer, F.J.A., Dijk, E.J. van, Velthuis, B.K., Dankbaar, J.W.
Přispěvatelé: Clinical Neurophysiology, Radiology and Nuclear Medicine, ACS - Microcirculation, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, Radiology and nuclear medicine
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Recurrent event
Neurology
Complications
Computed Tomography Angiography
UT-Hybrid-D
Perfusion scanning
030204 cardiovascular system & hematology
Brain Ischemia
03 medical and health sciences
0302 clinical medicine
Risk Factors
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Risk factor
Stroke
Computed tomography
Survival analysis
Neuroradiology
Diagnostic Neuroradiology
Ischemic Stroke
medicine.diagnostic_test
business.industry
Proportional hazards model
medicine.disease
Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Computerized tomography
Prognosis
Perfusion
Angiography
Neurology (clinical)
Radiology
Cardiology and Cardiovascular Medicine
business
Tomography
X-Ray Computed
030217 neurology & neurosurgery
Brain infarction
Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Zdroj: Neuroradiology
Neuroradiology. Springer
Neuroradiology, 63(4). Springer Verlag
Neuroradiology, 63, 483-490
Neuroradiology, 63(4), 483-490. Springer Verlag
Neuroradiology, 63, 4, pp. 483-490
Neuroradiology, 63, 483-490. SPRINGER
Kauw, F, Greving, J P, Takx, R A P, de Jong, H W A M & On behalf of the Dutch acute stroke study (DUST) investigators 2021, ' Prediction of long-term recurrent ischemic stroke : the added value of non-contrast CT, CT perfusion, and CT angiography ', Neuroradiology, vol. 63, no. 4, pp. 483-490 . https://doi.org/10.1007/s00234-020-02526-5
ISSN: 1432-1920
0028-3940
DOI: 10.1007/s00234-020-02526-5
Popis: Purpose The aim of this study was to evaluate whether the addition of brain CT imaging data to a model incorporating clinical risk factors improves prediction of ischemic stroke recurrence over 5 years of follow-up. Methods A total of 638 patients with ischemic stroke from three centers were selected from the Dutch acute stroke study (DUST). CT-derived candidate predictors included findings on non-contrast CT, CT perfusion, and CT angiography. Five-year follow-up data were extracted from medical records. We developed a multivariable Cox regression model containing clinical predictors and an extended model including CT-derived predictors by applying backward elimination. We calculated net reclassification improvement and integrated discrimination improvement indices. Discrimination was evaluated with the optimism-corrected c-statistic and calibration with a calibration plot. Results During 5 years of follow-up, 56 patients (9%) had a recurrence. The c-statistic of the clinical model, which contained male sex, history of hyperlipidemia, and history of stroke or transient ischemic attack, was 0.61. Compared with the clinical model, the extended model, which contained previous cerebral infarcts on non-contrast CT and Alberta Stroke Program Early CT score greater than 7 on mean transit time maps derived from CT perfusion, had higher discriminative performance (c-statistic 0.65, P = 0.01). Inclusion of these CT variables led to a significant improvement in reclassification measures, by using the net reclassification improvement and integrated discrimination improvement indices. Conclusion Data from CT imaging significantly improved the discriminatory performance and reclassification in predicting ischemic stroke recurrence beyond a model incorporating clinical risk factors only.
Databáze: OpenAIRE
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