Sporns Peter B, Höhne Marco, Meyer Lennart, Krogias Christos, Puetz Volker, Thierfelder Kolja M, Duering Marco, Kaiser Daniel, Langner Sönke, Brehm Alex, Rotkopf Lukas T, Kunz Wolfgang G, Fiehler Jens, Heindel Walter, Schramm Peter, Wiendl Heinz, Minnerup Heike, Psychogios Marios Nikos, Kemmling André, Minnerup Jens
Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Stroke. 2022 Sep;24(3):390-395. doi: 10.5853/jos.2022.00220. Epub 2022 Sep 30.
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.
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.
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%.
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.
许多中风患者无法接受静脉溶栓治疗，因为症状发作时间不明。我们测试了一种基于计算机断层扫描（CT）的简单方法，通过对缺血组织中的水摄取进行量化，能否识别出症状发作在4.5小时内的中风患者。
这项对MissPerfeCT研究（2009年8月至2017年11月）的回顾性分析纳入了来自七个三级中风中心的症状发作时间已知的连续患者。我们基于感兴趣区域（ROI）测量开发了一种简化算法，以量化缺血性病变的水摄取，从而量化症状发作在4.5小时内及超过4.5小时的时间。灌注CT用于识别缺血性脑组织，并在非增强CT中测量其密度，并与对侧半球相应区域的密度相关联，以量化病变的水摄取。
在263例患者中，204例（77.6%）在4.5小时内进行了CT检查。与症状发作超过4.5小时的患者（12.7%；95%置信区间[CI]，10.7%至14.7%）相比，症状发作在4.5小时内的患者水摄取显著更低（6.7%；95%CI，6.0%至7.4%）。根据水摄取百分比区分这些患者组的曲线下面积为0.744，最佳截断值为9.5%。根据此截断值，阳性预测值为88.8%，敏感性为73.5%，特异性为67.8%，阴性预测值为42.6%。
对于症状发作时间不明的缺血性中风患者，可使用基于ROI的方法在入院时通过非增强头部CT评估水摄取，以识别出处于4.5小时时间范围内的患者。
Zotero 插件
