Lansberg Maarten G, Thijs Vincent N, Hamilton Scott, Schlaug Gottfried, Bammer Roland, Kemp Stephanie, Albers Gregory W
Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA 94304, USA.
Stroke. 2007 Jun;38(6):1826-30. doi: 10.1161/STROKEAHA.106.480145. Epub 2007 May 10.
The perfusion-diffusion mismatch (PDM) model has been proposed as a tool to select acute stroke patients who are most likely to benefit from reperfusion therapy. The clinical-diffusion mismatch (CDM) model is an alternative method that is technically less challenging because it does not require perfusion-weighted imaging. This study is an evaluation of these 2 models in the DEFUSE dataset.
DEFUSE is an open-label multicenter study in which acute stroke patients were treated with intravenous tPA between 3 and 6 hours after symptoms onset and an MRI was obtained before and 3 to 6 hours after treatment. Presence of PDM and CDM was determined for each patient.
Based on conventional predefined mismatch criteria, PDM was present in 54% of the DEFUSE population and CDM in 62%. There was no agreement beyond chance between the 2 mismatch models (kappa 0.07). The presence of PDM was associated with an increased chance of favorable clinical response after reperfusion (OR, 5.4; P=0.039). Reperfusion was not associated with a significant increase in the rate of favorable clinical response in patients with CDM (OR, 2.2; P=0.34). Using optimized mismatch criteria, determined retrospectively based on DEFUSE data, the OR for favorable clinical response was 70 (P=0.001) for PDM and 5.1 (P=0.066) for CDM.
The PDM model appears to be more accurate than the CDM model for selecting patients who are likely to benefit from reperfusion therapy in the 3- to 6-hour time window.
灌注-弥散不匹配(PDM)模型已被提议作为一种工具,用于筛选最有可能从再灌注治疗中获益的急性卒中患者。临床-弥散不匹配(CDM)模型是另一种方法,在技术上挑战性较小,因为它不需要灌注加权成像。本研究旨在评估DEFUSE数据集中的这两种模型。
DEFUSE是一项开放标签的多中心研究,急性卒中患者在症状发作后3至6小时接受静脉注射tPA治疗,并在治疗前及治疗后3至6小时进行MRI检查。确定每位患者是否存在PDM和CDM。
根据传统的预定义不匹配标准,DEFUSE队列中54%的患者存在PDM,62%的患者存在CDM。两种不匹配模型之间的一致性无统计学意义(kappa值为0.07)。PDM的存在与再灌注后临床良好反应的可能性增加相关(OR为5.4;P=0.039)。再灌注与CDM患者临床良好反应率的显著增加无关(OR为2.2;P=0.34)。使用基于DEFUSE数据回顾性确定的优化不匹配标准,PDM患者临床良好反应的OR为70(P=0.001),CDM患者为5.1(P=0.066)。
在3至6小时时间窗内,对于筛选可能从再灌注治疗中获益的患者,PDM模型似乎比CDM模型更准确。