Sporns Peter B, Kemmling André, Minnerup Heike, Meyer Lennart, Krogias Christos, Puetz Volker, Thierfelder Kolja, Duering Marco, Kaiser Daniel, Langner Soenke, Massoth Christina, Brehm Alex, Rotkopf Lukas, Kunz Wolfgang G, Karch André, Fiehler Jens, Heindel Walter, Schramm Peter, Royl Georg, Wiendl Heinz, Psychogios Marios, Minnerup Jens
From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany.
Neurology. 2021 Nov 23;97(21):e2088-e2095. doi: 10.1212/WNL.0000000000012891. Epub 2021 Oct 14.
To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset.
We therefore performed the Retrospective Multicenter Hypoperfusion-Hypodensity Mismatch for The identification of Patients With Stroke Within 4.5 Hours study of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure.
Of 666 patients, 548 (82.3%) had multimodal CT within 4.5 hours and 118 (17.7%) beyond 4.5 hours. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% confidence interval [CI] 91.9%-95.8%) sensitivity, 74.6% (95% CI 66.0%-81.6%) specificity, 94.5% (95% CI 92.3%-96.1%) positive predictive value, and 73.3% (95% CI 64.8%-80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ = 0.61, 95% CI 0.53-0.69).
Patients with acute ischemic stroke with absence of a hypodensity on native CT (NCCT) within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset.
ClinicalTrials.gov Identifier: NCT04277728.
This study provides Class III evidence that CT hypoperfusion-hypodensity mismatch identifies patients with stroke within 4.5 hours of onset.
检验CT灌注减低-低密度不匹配可识别症状发作4.5小时内缺血性脑卒中患者这一假说。
因此，我们开展了“回顾性多中心灌注减低-低密度不匹配用于识别4.5小时内脑卒中患者”研究，纳入急性缺血性脑卒中患者且已知症状发作时间。灌注减低-低密度不匹配用于识别症状发作4.5小时内患者的预测值为主要观察指标。
666例患者中，548例（82.3%）在4.5小时内进行了多模态CT检查，118例（17.7%）在4.5小时后进行检查。症状发作4.5小时内的患者中有516例（94.2%）可见灌注减低-低密度不匹配，症状发作4.5小时后的患者中有30例（25.4%）可见。CT灌注减低-低密度不匹配识别卒中发作4.5小时内患者的敏感度为94.2%（95%置信区间[CI]91.9%-95.8%），特异度为74.6%（95%CI 66.0%-81.6%），阳性预测值为94.5%（95%CI 92.3%-96.1%），阴性预测值为73.3%（95%CI 64.8%-80.4%）。灌注减低-低密度不匹配的观察者间一致性较高（κ=0.61，95%CI 0.53-0.69）。
灌注CT上灌注减低核心病灶内平扫CT（NCCT）无低密度的急性缺血性脑卒中患者（灌注减低-低密度不匹配）可能处于溶栓时间窗内。应用此方法可能有助于指导对卒中发作时间不明患者是否进行溶栓的决策。
ClinicalTrials.gov标识符：NCT04277728。
本研究提供III级证据表明CT灌注减低-低密度不匹配可识别发作4.5小时内的脑卒中患者。
