Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
J Magn Reson Imaging. 2022 Sep;56(3):884-892. doi: 10.1002/jmri.28107. Epub 2022 Feb 16.
Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center.
To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI.
Prospective cohort study.
A total of 118 patients with acute MRI and symptoms of ischemic stroke.
A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar).
Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard.
Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam's restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant.
Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI.
EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke.
2 TECHNICAL EFFICACY: Stage 2.
快速 78 秒多对比度回波平面 MRI（EPIMix）在综合卒中中心检测梗死方面表现出良好的诊断性能，但在初级卒中中心的前瞻性研究中，其诊断性能尚未得到评估。
前瞻性确定 EPIMix 在检测缺血性病变方面是否不劣于常规临床 MRI。
前瞻性队列研究。
共 118 例急性 MRI 且有缺血性卒中症状的患者。
3T 的 EPIMix（基于回波平面的：T1-FLAIR、T2 加权、T2-FLAIR、T2*、DWI）和常规临床 MRI 序列（T1 加权快速自旋回波、T2 加权 PROPELLER、T2 加权-FLAIR 快速自旋回波、T2*梯度回波回波平面、DWI 自旋回波回波平面）。
三位放射科医生，对临床信息不知情，评估 EPIMix 和常规临床 MRI 上的缺血性病变（DWI↑、ADC↓和 T2/T2-FLAIR↑）的征象，有分歧时以第四位读者的共识意见解决，以建立参考标准。
使用 Nam 的限制性最大似然估计（RMLE）评分评估包括对参考标准的敏感性和特异性在内的诊断性能。使用 Nam 的 RMLE 评分，对 EPIMix 的敏感性进行非劣效性检验，以与参考标准进行比较。P 值<0.05 被认为具有统计学意义。
在 118 例患者中（平均年龄 62±16 岁，58%为男性），25%（n=30）有急性梗死的 MRI 征象。EPIMix 的敏感性为 97%（95%CI 83-100），读者 1 为 100%（95%CI 88-100），读者 2 为 100%（95%CI 88-100），读者 3 为 90%（95%CI 88-98），而读者 1 和 2 的常规临床 MRI 为 93%（95%CI 78-99），读者 3 为 90%（95%CI 74-98）。特异性为读者 1 的 99%（95%CI 94-100），读者 2 的 100%（95%CI 96-100），读者 3 的 98%（95%CI 92-100），而所有读者的常规临床 MRI 为 100%（95%CI 96-100）。
EPIMix 在诊断急性缺血性卒中方面与常规临床 MRI 不劣。
2 级技术功效。
