Peter B Sporns1,2, Marco Höhne3, Lennart Meyer4, Christos Krogias5, Volker Puetz6,7, Kolja M Thierfelder8, Marco Duering9,10, Daniel Kaiser7,11, Sönke Langner8, Alex Brehm1, Lukas T Rotkopf12, Wolfgang G Kunz13, Jens Fiehler2, Walter Heindel3, Peter Schramm14, Heinz Wiendl4, Heike Minnerup15, Marios Nikos Psychogios1, André Kemmling16, Jens Minnerup4. 1. Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland. 2. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Radiology, University Hospital of Münster, Westfaelische Wilhelms-University of Münster, Münster, Germany. 4. Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany. 5. Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany. 6. Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany. 7. Neurovascular Center Dresden, University Hospital Carl Gustav Carus, Dresden, Germany. 8. Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany. 9. Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland. 10. Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany. 11. Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany. 12. Department of Radiology, German Cancer Research Center, Heidelberg, Germany. 13. Department of Radiology, University Hospital, LMU Munich, Munich, Germany. 14. Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany. 15. Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany. 16. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Marburg, Marburg University, Marburg, Germany.
Abstract
BACKGROUND AND PURPOSE: Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. METHODS: This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. RESULTS: Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. CONCLUSIONS: Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
BACKGROUND AND PURPOSE: Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. METHODS: This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. RESULTS: Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. CONCLUSIONS: Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
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