Division of Neurology, University of Alberta, Alberta, Canada.
Stroke. 2011 Aug;42(8):2143-8. doi: 10.1161/STROKEAHA.111.613752. Epub 2011 Jun 23.
The Oxfordshire Community Stroke Project (OCSP) is a common clinical stroke classification tool. We evaluated the accuracy of OCSP classification with a prospective magnetic resonance imaging (MRI) study.
Stroke/transient ischemic attack patients presenting within 48 hours of onset were included in the study (n=130). Following computed tomography scan, OCSP classification, total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacunar circulation infarcts (LACI), and posterior circulation infarcts (POCI) were performed by 3 independent examiners. All patients underwent diffusion-weighted MRI with planimetric volume measurement and classification into OCSP categories, organized by lesion location.
Patients were clinically classified as TACI (12 patients), PACI (62 patients), LACI (38 patients), and POCI (18 patients). In 101 patients with diffusion-weighted MRI lesions, correct classification rates were: TACI (83.3%), PACI (83%), LACI (39%), and POCI (86%). OCSP had the following sensitivity (SE), specificity (SP), and positive predictive value (PPV): TACI (SE, 100%; SP, 98%; PPV, 83%), PACI (SE, 73%; SP, 78%; PPV, 83%), LACI (SE, 47%; SP, 83%; PPV, 39%), and POCI (SE, 92%; SP, 98%; PPV, 86%). Sixty-one percent of patients in the LACI group had radiographic appearances consistent with PACI, and 15% of those classified as PACI had lacunar infarcts. No differences in stroke severity existed between patients classified correctly (median National Institutes of Health Stroke Scale [NIHSS]=4; interquartile range [IQR]=7) or incorrectly (median NIHSS=3; IQR=3). Patients classified correctly had larger infarct volume (median=6.75 mL; IQR=33.2) than did those who were incorrectly classified (1.86 mL; IQR=5; P=0.008).
OCSP classification does not permit accurate discrimination between lacunar and small-volume cortical infarcts. Differential patterns of investigation for stroke etiology should not be based solely on clinical criteria.
牛津社区卒中项目（OCSP）是一种常用的临床卒中分类工具。我们通过前瞻性磁共振成像（MRI）研究来评估 OCSP 分类的准确性。
本研究纳入了发病后 48 小时内就诊的卒中和短暂性脑缺血发作患者（n=130）。在进行计算机断层扫描后，由 3 位独立的检查者进行 OCSP 分类、全前循环梗死（TACI）、部分前循环梗死（PACI）、腔隙性循环梗死（LACI）和后循环梗死（POCI）。所有患者均接受了扩散加权 MRI 检查，通过病变部位进行平面测量和 OCSP 分类。
患者的临床分类为 TACI（12 例）、PACI（62 例）、LACI（38 例）和 POCI（18 例）。在 101 例有弥散加权 MRI 病变的患者中，正确分类率为：TACI（83.3%）、PACI（83%）、LACI（39%）和 POCI（86%）。OCSP 的灵敏度（SE）、特异性（SP）和阳性预测值（PPV）分别为：TACI（SE，100%；SP，98%；PPV，83%）、PACI（SE，73%；SP，78%；PPV，83%）、LACI（SE，47%；SP，83%；PPV，39%）和 POCI（SE，92%；SP，98%；PPV，86%）。LACI 组中有 61%的患者影像学表现与 PACI 一致，而被分类为 PACI 的患者中有 15%存在腔隙性梗死。正确分类和错误分类的患者之间，卒中严重程度没有差异（正确分类患者的中位数 NIHSS 评分=4；四分位距[IQR]=7，错误分类患者的中位数 NIHSS 评分=3；IQR=3）。正确分类的患者梗死体积较大（中位数=6.75 mL；IQR=33.2），而错误分类的患者梗死体积较小（1.86 mL；IQR=5；P=0.008）。
OCSP 分类不能准确区分腔隙性和小体积皮质梗死。针对卒中病因的不同检查方法不应仅基于临床标准。
