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Jiang L, Miao Z, Chen H, Geng W, Yong W, Chen YC, Zhang H, Duan S, Yin X, Zhang Z. Radiomics Analysis of Diffusion-Weighted Imaging and Long-Term Unfavorable Outcomes Risk for Acute Stroke. Stroke 2023; 54:488-498. [PMID: 36472198 DOI: 10.1161/strokeaha.122.040418] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diffusion-weighted imaging radiomics could be used as prognostic biomarkers in acute ischemic stroke. We aimed to identify a clinical and diffusion-weighted imaging radiomics model for individual unfavorable outcomes risk assessment in acute ischemic stroke. METHODS A total of 1716 patients with acute ischemic stroke from 2 centers were divided into a training cohort and a validation cohort. Patient outcomes were measured with the modified Rankin Scale score. An unfavorable outcome was defined as a modified Rankin Scale score greater than 2. The primary end point was all-cause mortality or outcomes 1 year after stroke. The MRI-DRAGON score was calculated based on previous publications. We extracted and selected the infarct features on diffusion-weighted imaging to construct a radiomic signature. The clinic-radiomics signature was built by measuring the Cox proportional risk regression score (CrrScore) and compared with the MRI-DRAGON score and the ClinicScore. CrrScore model performance was estimated by 1-year unfavorable outcomes prediction. RESULTS A high radiomic signature predicted a higher probability of unfavorable outcomes than a low radiomic signature in the training (hazard ratio, 3.19 [95% CI, 2.51-4.05]; P<0.0001) and validation (hazard ratio, 3.25 [95% CI, 2.20-4.80]; P<0.0001) cohorts. The diffusion-weighted imaging Alberta Stroke Program Early CT Score, age, glucose level before therapy, National Institutes of Health Stroke Scale score on admission, glycated hemoglobin' radiomic signature, hemorrhagic infarction, and malignant cerebral edema were associated with an unfavorable outcomes risk after multivariable adjustment. A CrrScore nomogram was developed to predict outcomes and had the best performance in the training (area under the curve, 0.862) and validation cohorts (area under the curve, 0.858). The CrrScore model time-dependent areas under the curve of the probability of unfavorable outcomes at 1 year in the training and validation cohorts were 0.811 and 0.801, respectively. CONCLUSIONS The CrrScore model allows the accurate prediction of patients with acute ischemic stroke outcomes and can potentially guide rehabilitation therapies for patients with different risks of unfavorable outcomes.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Zhengfei Miao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Wei Yong
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Hong Zhang
- Department of Radiology, Affiliated Jiangning Hospital of Nanjing Medical University, China (H.Z.)
| | - Shaofeng Duan
- GE Healthcare' Precision Health Institution' China (S.D.)
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, China (L.J., Z.M., H.C., W.G., W.Y., Y.-C.C., X.Y.)
| | - Zhiqiang Zhang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, China (Z.Z.)
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Adams HP. Clinical Scales to Assess Patients With Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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Kremers F, Venema E, Duvekot M, Yo L, Bokkers R, Lycklama À. Nijeholt G, van Es A, van der Lugt A, Majoie C, Burke J, Roozenbeek B, Lingsma H, Dippel D. Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation. Stroke 2021; 53:825-836. [PMID: 34732070 PMCID: PMC8884132 DOI: 10.1161/strokeaha.120.033445] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text. Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.
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Affiliation(s)
- Femke Kremers
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
| | - Esmee Venema
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
- Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.)
| | - Martijne Duvekot
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
- Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.D.)
| | - Lonneke Yo
- Radiology, Catharina Medical Center, Eindhoven, the Netherlands (L.Y.)
| | - Reinoud Bokkers
- Radiology, UMCG Groningen Medical Center, the Netherlands (R.B.)
| | | | - Adriaan van Es
- Radiology, Leiden Medical Center, the Netherlands (A.v.E.)
| | - Aad van der Lugt
- Radiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.v.d.L.)
| | - Charles Majoie
- Radiology, Amsterdam Medical Center, the Netherlands (C.M.)
| | - James Burke
- Neurology, University of Michigan, Ann Arbor (J.B.)
| | - Bob Roozenbeek
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
| | - Hester Lingsma
- Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.)
| | - Diederik Dippel
- Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.)
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Riou-Comte N, Gory B, Soudant M, Zhu F, Xie Y, Humbertjean L, Mione G, Oppenheim C, Guillemin F, Bracard S, Richard S. Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis. Stroke Vasc Neurol 2021; 6:631-639. [PMID: 34103393 PMCID: PMC8717776 DOI: 10.1136/svn-2020-000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT. Methods We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic. Results Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80). Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm. Trial registration number NCT01062698.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Marc Soudant
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Yu Xie
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Gioia Mione
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, INSERM U894, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Sébastien Richard
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
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Jiang B, Zhu G, Xie Y, Heit JJ, Chen H, Li Y, Ding V, Eskandari A, Michel P, Zaharchuk G, Wintermark M. Prediction of Clinical Outcome in Patients with Large-Vessel Acute Ischemic Stroke: Performance of Machine Learning versus SPAN-100. AJNR Am J Neuroradiol 2021; 42:240-246. [PMID: 33414230 DOI: 10.3174/ajnr.a6918] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/12/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Traditional statistical models and pretreatment scoring systems have been used to predict the outcome for acute ischemic stroke patients (AIS). Our aim was to select the most relevant features in terms of outcome prediction on the basis of machine learning algorithms for patients with acute ischemic stroke and to compare the performance between multiple models and the Stroke Prognostication Using Age and National Institutes of Health Stroke Scale (SPAN-100) index model. MATERIALS AND METHODS A retrospective multicenter cohort of 1431 patients with acute ischemic stroke was subdivided into recanalized and nonrecanalized patients. Extreme Gradient Boosting machine learning models were built to predict the mRS score at 90 days using clinical, imaging, combined, and best-performing features. Feature selection was performed using the relative weight and frequency of occurrence in the models. The model with the best performance was compared with the SPAN-100 index model using area under the receiver operating curve analysis. RESULTS In 3 groups of patients, the baseline NIHSS was the most significant predictor of outcome among all the parameters, with relative weights of 0.36∼0.69; ischemic core volume on CTP ranked as the most important imaging biomarker with relative weights of 0.29∼0.47. The model with the best-performing features had a better performance than the other machine learning models. The area under the curve of the model with the best-performing features was higher than SPAN-100 model and reached statistical significance for the total (P < .05) and the nonrecanalized patients (P < .001). CONCLUSIONS Machine learning-based feature selection can identify parameters with higher performance in outcome prediction. Machine learning models with the best-performing features, especially advanced CTP data, had superior performance of the recovery outcome prediction for patients with stroke at admission in comparison with SPAN-100.
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Affiliation(s)
- B Jiang
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - G Zhu
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - Y Xie
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - J J Heit
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - H Chen
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - Y Li
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - V Ding
- Department of Medicine (V.D.), Quantitative Sciences Unit, Stanford University, Stanford, California
| | - A Eskandari
- Neurology Service (A.E., P.M.), Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne, Switzerland
| | - P Michel
- Neurology Service (A.E., P.M.), Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne, Switzerland
| | - G Zaharchuk
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
| | - M Wintermark
- From the Department of Radiology, Neuroradiology Section (B.J., G.Z., Y.X., J.J.H., H.C., Y.L., G.Z., M.W.), Stanford University School of Medicine, Palo Alto, California
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Xu K, Gu B, Zuo T, Xu X, Chen YC, Yin X, Feng G. Predictive value of Alberta stroke program early CT score for perfusion weighted imaging - diffusion weighted imaging mismatch in stroke with middle cerebral artery occlusion. Medicine (Baltimore) 2020; 99:e23490. [PMID: 33327283 PMCID: PMC7738142 DOI: 10.1097/md.0000000000023490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to quantitatively assess the consistency and correlation between perfusion weighted imaging (PWI)/ diffusion weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) mismatch and PWI/DWI mismatch.Sixty-eight acute ischemic stroke with middle cerebral artery occlusion who underwent magnetic resonance imaging before thrombectomy were eligible. DWI volume, PWI volume and PWI-DWI mismatch were measured. DWI-, PWI-, PWI-DWI ASPECTS were evaluated. Statistical analysis was performed to compare the correlation between volume and ASPECTS of DWI-, PWI- and PWI-DWI mismatch. Receiver operating characteristic curve analysis was used to assess the predictive value of the PWI-DWI ASPECTS mismatch for the occurrence of PWI-DWI mismatch in acute ischemic stroke patients with middle cerebral artery occlusion.Of 68 patients, the DWI volume, PWI volume and PWI-DWI mismatch volume were (27.76 ± 17.53) mL, (167.09 ± 59.64) mL and (139.33 ± 58.18) mL respectively. DWI-ASPECTS was 6.75 ± 1.90 with the interobserver agreement was κ=0.98 (95% CI, 0.95-0.99); PWI-ASPECTS was 3.09 ± 2.11 with the interobserver agreement was κ=0.95 (95% CI, 0.91-0.99); PWI-DWI ASPECTS mismatch was 6.75 ± 1.90. Spearman's rank correlation analysis revealed that PWI-DWI mismatch volume was negatively correlated with PWI-DWI ASPECTS mismatch (r = -0.802; P = .000). Receiver operating characteristic analysis showed that when the PWI-DWI ASPECTS mismatch cut point was ≥ 2, the under curve of PWI-DWI ASPECTS mismatch for predicting PWI-DWI mismatch was 0.954 (95%CI, 0.911-0.998), with the sensitivity and specificity were 84.00% and 100% respectively.PWI-DWI ASPECTS mismatch may represent a convenient surrogate for penumbra in clinical trials.
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Affiliation(s)
| | - Baodong Gu
- Department of Neurology, Affiliated Lianyungang Traditional Chinese Medicine Hospital of Kangda College of Nanjing Medical University, Lianyungang
| | | | | | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guangkui Feng
- Department of Neurology, Affiliated Lianyungang Traditional Chinese Medicine Hospital of Kangda College of Nanjing Medical University, Lianyungang
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Lesenne A, Grieten J, Ernon L, Wibail A, Stockx L, Wouters PF, Dreesen L, Vandermeulen E, Van Boxstael S, Vanelderen P, Van Poucke S, Vundelinckx J, Van Cauter S, Mesotten D. Prediction of Functional Outcome After Acute Ischemic Stroke: Comparison of the CT-DRAGON Score and a Reduced Features Set. Front Neurol 2020; 11:718. [PMID: 32849196 PMCID: PMC7412791 DOI: 10.3389/fneur.2020.00718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: The CT-DRAGON score was developed to predict long-term functional outcome after acute stroke in the anterior circulation treated by thrombolysis. Its implementation in clinical practice may be hampered by its plethora of variables. The current study was designed to develop and evaluate an alternative score, as a reduced set of features, derived from the original CT-DRAGON score. Methods: This single-center retrospective study included 564 patients treated for stroke, in the anterior and the posterior circulation. At 90 days, favorable [modified Rankin Scale score (mRS) of 0–2] and miserable outcome (mRS of 5–6) were predicted by the CT-DRAGON in 427 patients. Bootstrap forests selected the most relevant parameters of the CT-DRAGON, in order to develop a reduced set of features. Discrimination, calibration and misclassification of both models were tested. Results: The area under the receiver operating characteristic curve (AUROC) for the CT-DRAGON was 0.78 (95% CI 0.74–0.81) for favorable and 0.78 (95% CI 0.72-0.83) for miserable outcome. Misclassification was 29% for favorable and 13.5% for miserable outcome, with a 100% specificity for the latter. National Institutes of Health Stroke Scale (NIHSS), pre-stroke mRS and age were identified as the strongest contributors to favorable and miserable outcome and named the reduced features set. While CT-DRAGON was only available in 323 patients (57%), the reduced features set could be calculated in 515 patients (91%) (p < 0.001). Misclassification was 25.8% for favorable and 14.4% for miserable outcome, with a 97% specificity for miserable outcome. The reduced features set had better discriminative power than CT-DRAGON for both outcomes (both p < 0.005), with an AUROC of 0.82 (95% CI 0.79–0.86) and 0.83 (95% CI 0.77–0.87) for favorable and miserable outcome, respectively. Conclusions: The CT-DRAGON score revealed acceptable discrimination in our cohort of both anterior and posterior circulation strokes, receiving all treatment modalities. The reduced features set could be measured in a larger cohort and with better discrimination. However, the reduced features set needs further validation in a prospective, multicentre study. Clinical Trial Registration: http://www.clinicaltrials.gov. Identifiers: NCT03355690, NCT04092543.
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Affiliation(s)
- Anouk Lesenne
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Jef Grieten
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium.,Department of Anesthesiology, VU University Amsterdam, Amsterdam, Netherlands
| | - Ludovic Ernon
- Department of Neurology, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Alain Wibail
- Department of Neurology, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Luc Stockx
- Department of Medical Imaging, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Patrick F Wouters
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Leentje Dreesen
- Department of Medical Imaging, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Elly Vandermeulen
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Sam Van Boxstael
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Pascal Vanelderen
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium.,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Sven Van Poucke
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Joris Vundelinckx
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Sofie Van Cauter
- Department of Medical Imaging, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Dieter Mesotten
- Department of Critical Care Services, Ziekenhuis Oost-Limburg Genk, Genk, Belgium.,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
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Qualitative Posttreatment Diffusion-Weighted Imaging as a Predictor of 90-day Outcome in Stroke Intervention. Can J Neurol Sci 2019; 47:160-166. [PMID: 31779719 DOI: 10.1017/cjn.2019.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim was to assess the ability of post-treatment diffusion-weighted imaging (DWI) to predict 90-day functional outcome in patients with endovascular therapy (EVT) for large vessel occlusion in acute ischemic stroke (AIS). METHODS We examined a retrospective cohort from March 2016 to January 2018, of consecutive patients with AIS who received EVT. Planimetric DWI was obtained and infarct volume calculated. Four blinded readers were asked to predict modified Rankin Score (mRS) at 90 days post-thrombectomy. RESULTS Fifty-one patients received endovascular treatment (mean age 65.1 years, median National Institutes of Health Stroke Scale (NIHSS) 18). Mean infarct volume was 43.7 mL. The baseline NIHSS, 24-hour NIHSS, and the DWI volume were lower for the mRS 0-2 group. Also, the thrombolysis in cerebral infarction (TICI) 2b/3 rate was higher in the mRS 0-2 group. No differences were found in terms of the occlusion level, reperfusion technique, or recombinant tissue plasminogen activator use. There was a significant association noted between average infarct volume and mRS at 90 days. On multivariable analysis, higher infarct volume was significantly associated with 90-day mRS 3-5 when adjusted to TICI scores and occlusion location (OR 1.01; CI 95% 1.001-1.03; p = 0.008). Area under curve analysis showed poor performance of DWI volume reader ability to qualitatively predict 90-day mRS. CONCLUSION The subjective impression of DWI as a predictor of clinical outcome is poorly correlated when controlling for premorbid status and other confounders. Qualitative DWI by experienced readers both overestimated the severity of stroke for patients who achieved good recovery and underestimated the mRS for poor outcome patients. Infarct core quantitation was reliable.
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Ben Hassen W, Raynaud N, Bricout N, Boulouis G, Legrand L, Ferrigno M, Kazemi A, Bretzner M, Soize S, Farhat W, Seners P, Turc G, Zuber M, Oppenheim C, Cordonnier C, Naggara O, Henon H. MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours. J Neurointerv Surg 2019; 12:246-251. [PMID: 31427503 DOI: 10.1136/neurintsurg-2019-015105] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort. METHODS Consecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed. RESULTS Among 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome. CONCLUSION The MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.
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Affiliation(s)
| | - Nicolas Raynaud
- Radiology, Centro-hospitalo Universitaire de Poitiers, Poitiers, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Laurence Legrand
- Department of Neuroradiology, Centre Hospitalier Sainte Anne, Paris, France
| | - Marc Ferrigno
- Inserm U1171-Degenerative and Vascular Cognitive Disorders, Lille, France.,Neurology-Stroke Unit, Univ Lille, CHU Lille, Lille, France
| | - Apolline Kazemi
- Interventional Neuroradiology, Univ Lille, CHU Lille, Lille, France
| | - Martin Bretzner
- Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Wassim Farhat
- Neurology, Centre Hospitalier Saint Joseph, Paris, France
| | - Pierre Seners
- Department of Neurorlogy, Centre Hospitalier Sainte Anne, Paris, France
| | - Guillaume Turc
- Department of Neurorlogy, Centre Hospitalier Sainte Anne, Paris, France
| | - Mathieu Zuber
- Neurology, Groupe Hospitalier Paris Saint Joseph, Paris, Île-de-France, France
| | | | | | | | - Hilde Henon
- Department of Vascular Neurology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
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10
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Jiang S, Peng Y, Jing CH, Fei AH, Wang HR, Gao CJ, Chen M, Li Y, Pan S. Endovascular thrombectomy can be beneficial to acute ischemic stroke patients with large infarcts. J Neurosurg 2019:1-8. [DOI: 10.3171/2017.11.jns171297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThis study aimed to assess whether patients with acute ischemic stroke (AIS) and large infarct lesions benefit from reperfusion management. To determine the efficacy of different recanalization managements on AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) < 6, the authors retrospectively analyzed hospitalized patients with AIS.METHODSEighty-nine patients with AIS and ASPECTS < 6 were screened from 13,285 hospitalized patients treated by thrombolysis, thrombectomy, or conventional care in two stroke medical centers. Logistic regression or Fisher’s exact test was performed for comparison of the outcome and risk events between patients treated by thrombectomy (or thrombolysis) and conventional care. The modified Rankin Scale (mRS) score was used to assess the major clinical outcome of patients 3 months after disease onset. Disease outcome was also examined by analyzing symptom improvement at discharge. In particular, mortality and symptomatic intracranial hemorrhage (sICH) were evaluated as risk factors.RESULTSThis study included 21 patients who received thrombolysis, 36 patients receiving thrombectomy, and 32 patients receiving conventional treatment. Among these 3 treatments, only the thrombectomy group clearly showed the most encouraging clinical outcome (mRS score 0–2; p < 0.05, Fisher’s exact test) and marked improvement (OR 25.84, 95% CI 2.44–273.59) compared with conventional treatment. It is noteworthy that the mortality rate of the thrombectomy and thrombolysis group was similar to that of the conventional group, and thrombectomy and thrombolysis increased the risk of sICH in comparison with conventional care (p < 0.05, Fisher’s exact test).CONCLUSIONSPatients with AIS and ASPECTS < 6 definitely benefited from thrombectomy with higher sICH risk, whereas thrombolysis management showed similar efficacy to the control group.
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Affiliation(s)
- Shaowei Jiang
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Ya Peng
- 3Cerebral Vascular Disease Center, The First People’s Hospital of Changzhou, Soochow University, Changzhou, China
| | - Chao-hui Jing
- 2Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; and
| | - Ai-hua Fei
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Hai-rong Wang
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Cheng-jin Gao
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Miao Chen
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yi Li
- 2Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; and
| | - Shuming Pan
- 1Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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11
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Drozdowska BA, Singh S, Quinn TJ. Thinking About the Future: A Review of Prognostic Scales Used in Acute Stroke. Front Neurol 2019; 10:274. [PMID: 30949127 PMCID: PMC6437031 DOI: 10.3389/fneur.2019.00274] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background: There are many prognostic scales that aim to predict functional outcome following acute stroke. Despite considerable research interest, these scales have had limited impact in routine clinical practice. This may be due to perceived problems with internal validity (quality of research), as well as external validity (generalizability of results). We set out to collate information on exemplar stroke prognosis scales, giving particular attention to the scale content, derivation, and validation. Methods: We performed a focused literature search, designed to return high profile scales that use baseline clinical data to predict mortality or disability. We described prognostic utility and collated information on the content, development and validation of the tools. We critically appraised chosen scales based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies (CHARMS). Results: We chose 10 primary scales that met our inclusion criteria, six of which had revised/modified versions. Most primary scales used 5 input variables (range: 4–13), with substantial overlap in the variables included. All scales included age, eight included a measure of stroke severity, while five scales incorporated pre-stroke level of function (often using modified Rankin Scale), comorbidities and classification of stroke type. Through our critical appraisal, we found issues relating to excluding patients with missing data from derivation studies, and basing the selection of model variable on significance in univariable analysis (in both cases noted for six studies). We identified separate external validation studies for all primary scales but one, with a total of 60 validation studies. Conclusions: Most acute stroke prognosis scales use similar variables to predict long-term outcomes and most have reasonable prognostic accuracy. While not all published scales followed best practice in development, most have been subsequently validated. Lack of clinical uptake may relate more to practical application of scales rather than validity. Impact studies are now necessary to investigate clinical usefulness of existing scales.
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Affiliation(s)
- Bogna A Drozdowska
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sarjit Singh
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
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12
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JOURNAL CLUB: Use of Gradient Boosting Machine Learning to Predict Patient Outcome in Acute Ischemic Stroke on the Basis of Imaging, Demographic, and Clinical Information. AJR Am J Roentgenol 2019; 212:44-51. [DOI: 10.2214/ajr.18.20260] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Clinical applications of diffusion weighted imaging in neuroradiology. Insights Imaging 2018; 9:535-547. [PMID: 29846907 PMCID: PMC6108979 DOI: 10.1007/s13244-018-0624-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/12/2018] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract Diffusion-weighted imaging (DWI) has revolutionised stroke imaging since its introduction in the mid-1980s, and it has also become a pillar of current neuroimaging. Diffusion abnormalities represent alterations in the random movement of water molecules in tissues, revealing their microarchitecture, and occur in many neurological conditions. DWI provides useful information, increasing the sensitivity of MRI as a diagnostic tool, narrowing the differential diagnosis, providing prognostic information, aiding in treatment planning and evaluating response to treatment. Recently, there have been several technical improvements in DWI, leading to reduced acquisition time and artefacts and enabling the development of diffusion tensor imaging (DTI) as a tool for assessing white matter. We aim to review the main clinical uses of DWI, focusing on the physiological mechanisms that lead to diffusion abnormalities. Common pitfalls will also be addressed. Teaching Points • DWI includes EPI, TSE, RESOLVE or EPI combined with reduced volume excitation. • DWI is the most sensitive sequence in stroke diagnosis and provides information about prognosis. • DWI helps in the detection of intramural haematomas (arterial dissection). • In diffusion imaging, ADC is inversely proportional to tumour cellularity. • DWI and DTI derived parameters can be used as biomarkers in different pathologies.
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14
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Heiss WD. Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke. Cerebrovasc Dis 2017; 44:266-276. [PMID: 28869961 DOI: 10.1159/000479594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022] Open
Abstract
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.
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15
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Soliman F, Gupta A, Delgado D, Kamel H, Pandya A. The Role of Imaging in Clinical Stroke Scales That Predict Functional Outcome: A Systematic Review. Neurohospitalist 2017; 7:169-178. [PMID: 28974995 DOI: 10.1177/1941874417708128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Numerous stroke scales have been developed to predict functional outcomes following acute ischemic stroke. The goal of this study was to summarize functional outcome scores in stroke that incorporate neuroimaging with those that don't incorporate neuroimaging. METHODS Searches were conducted in Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database from inception to January 23, 2015. Additional records were identified by employing the "Cited by" and "View References" features in Scopus. We included studies that described stroke prognosis models or scoring systems that predict functional outcome based on clinical and/or imaging data available on presentation. Score performance was evaluated based on area under the receiver operating characteristic curve (AUC). RESULTS A total of 3300 articles were screened, yielding 14 scores that met inclusion criteria. Half (7) of the scores included neuroimaging as a predictor variable. Neuroimaging parameters included infarct size on magnetic resonance diffusion-weighted imaging, infarct size defined by computed tomography hypodensity, and hemodynamic abnormality on perfusion imaging. The modified Rankin Scale at 3 months poststroke was the most common functional outcome reported (13 of 14 scores). The AUCs ranged from 0.64 to 0.84 for scores that included neuroimaging as a predictor and 0.64 to 0.94 for scores that did not include neuroimaging. External validation has been performed for 7 scores. CONCLUSIONS Due to the marked heterogeneity in the scores and populations in which they were applied, it is unclear whether current imaging-based scores offer advantages over simpler approaches for predicting poststroke function.
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Affiliation(s)
- Fatima Soliman
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
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16
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Liu D, Scalzo F, Rao NM, Hinman JD, Kim D, Ali LK, Saver JL, Sun W, Dai Q, Liu X, Liebeskind DS. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity Topography, Novel Imaging Marker for Revascularization in Middle Cerebral Artery Occlusion. Stroke 2016; 47:2763-2769. [PMID: 27659851 DOI: 10.1161/strokeaha.116.013953] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In acute arterial occlusion, fluid-attenuated inversion recovery vascular hyperintensity (FVH) has been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH topography or FVH-Alberta Stroke Program Early CT Score (ASPECTS) pattern and outcome in acute M1-middle cerebral artery occlusion patients with endovascular treatment. METHODS We included acute M1-middle cerebral artery occlusion patients treated with endovascular therapy (ET). All patients had diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery before ET. Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. The presence of FVH inside and outside DWI-positive lesions was separately analyzed. Clinical outcome after ET was analyzed with respect to different distal FVH-ASPECTS topography. RESULTS Among 101 patients who met inclusion criteria for the study, mean age was 66.2±17.8 years and median National Institutes of Health Stroke Scale was 17.0 (interquartile range, 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (modified Rankin Scale [mRS] score of 0-2; 8.0 versus 4.0, P<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (odds ratio, 1.3; 95% confidence interval, 1.06-1.68; P=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhagic transformation (odds ratio, 1.3; 95% confidence interval, 1.04-1.51; P=0.019). CONCLUSIONS Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing ET. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhagic transformation. The FVH pattern, not number, can serve as an imaging selection marker for ET in acute middle cerebral artery occlusion.
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Affiliation(s)
- Dezhi Liu
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Fabien Scalzo
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Neal M Rao
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Jason D Hinman
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Doojin Kim
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Latisha K Ali
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Jeffrey L Saver
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Wen Sun
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Qiliang Dai
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - Xinfeng Liu
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles
| | - David S Liebeskind
- From the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (D.L., W.S., Q.D., X.L.); and Department of Neurology, Neurovascular Imaging Research Core (D.L., F.S., D.S.L.) and Department of Neurology, UCLA Stroke Center (D.L., F.S., N.M.R., J.D.H., D.K., L.K.A., J.L.S., D.S.L.), University of California Los Angeles.
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17
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Lassalle L, Turc G, Tisserand M, Charron S, Roca P, Lion S, Legrand L, Edjlali M, Naggara O, Meder JF, Mas JL, Baron JC, Oppenheim C. ASPECTS (Alberta Stroke Program Early CT Score) Assessment of the Perfusion-Diffusion Mismatch. Stroke 2016; 47:2553-8. [PMID: 27625381 DOI: 10.1161/strokeaha.116.013676] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Rapid and reliable assessment of the perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch is required to promote its wider application in both acute stroke clinical routine and trials. We tested whether an evaluation based on the Alberta Stroke Program Early CT Score (ASPECTS) reliably identifies the PWI/DWI mismatch. METHODS A total of 232 consecutive patients with acute middle cerebral artery stroke who underwent pretreatment magnetic resonance imaging (PWI and DWI) were retrospectively evaluated. PWI-ASPECTS and DWI-ASPECTS were determined blind from manually segmented PWI and DWI volumes. Mismatch-ASPECTS was defined as the difference between PWI-ASPECTS and DWI-ASPECTS (a high score indicates a large mismatch). We determined the mismatch-ASPECTS cutoff that best identified the volumetric mismatch, defined as VolumeTmax>6s/VolumeDWI≥1.8, a volume difference≥15 mL, and a VolumeDWI<70 mL. RESULTS Inter-reader agreement was almost perfect for PWI-ASPECTS (κ=0.95 [95% confidence interval, 0.90-1]), and DWI-ASPECTS (κ=0.96 [95% confidence interval, 0.91-1]). There were strong negative correlations between volumetric and ASPECTS-based assessments of DWI lesions (ρ=-0.84, P<0.01) and PWI lesions (ρ=-0.90, P<0.01). Receiver operating characteristic curve analysis showed that a mismatch-ASPECTS ≥2 best identified a volumetric mismatch, with a sensitivity of 0.93 (95% confidence interval, 0.89-0.98) and a specificity of 0.82 (95% confidence interval, 0.74-0.89). CONCLUSIONS The mismatch-ASPECTS method can detect a true mismatch in patients with acute middle cerebral artery stroke. It could be used for rapid screening of patients with eligible mismatch, in centers not equipped with ultrafast postprocessing software.
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Affiliation(s)
- Louis Lassalle
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marie Tisserand
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sylvain Charron
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Stephanie Lion
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-François Meder
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (L. Lassalle, M.T., S.C., P.R., S.L., L. Legrand, M.E., O.N., J.-F.M., C.O.), and Neurology (G.T., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France.
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Ntaios G, Gioulekas F, Papavasileiou V, Strbian D, Michel P. ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians. Eur J Neurol 2016; 23:1651-1657. [PMID: 27456206 DOI: 10.1111/ene.13100] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE ASTRAL, SEDAN and DRAGON scores are three well-validated scores for stroke outcome prediction. Whether these scores predict stroke outcome more accurately compared with physicians interested in stroke was investigated. METHODS Physicians interested in stroke were invited to an online anonymous survey to provide outcome estimates in randomly allocated structured scenarios of recent real-life stroke patients. Their estimates were compared to scores' predictions in the same scenarios. An estimate was considered accurate if it was within 95% confidence intervals of actual outcome. RESULTS In all, 244 participants from 32 different countries responded assessing 720 real scenarios and 2636 outcomes. The majority of physicians' estimates were inaccurate (1422/2636, 53.9%). 400 (56.8%) of physicians' estimates about the percentage probability of 3-month modified Rankin score (mRS) > 2 were accurate compared with 609 (86.5%) of ASTRAL score estimates (P < 0.0001). 394 (61.2%) of physicians' estimates about the percentage probability of post-thrombolysis symptomatic intracranial haemorrhage were accurate compared with 583 (90.5%) of SEDAN score estimates (P < 0.0001). 160 (24.8%) of physicians' estimates about post-thrombolysis 3-month percentage probability of mRS 0-2 were accurate compared with 240 (37.3%) DRAGON score estimates (P < 0.0001). 260 (40.4%) of physicians' estimates about the percentage probability of post-thrombolysis mRS 5-6 were accurate compared with 518 (80.4%) DRAGON score estimates (P < 0.0001). CONCLUSIONS ASTRAL, DRAGON and SEDAN scores predict outcome of acute ischaemic stroke patients with higher accuracy compared to physicians interested in stroke.
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Affiliation(s)
- G Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece.
| | - F Gioulekas
- Sub-directorate of Informatics, Larissa General University Hospital, Larissa, Greece
| | - V Papavasileiou
- Department of Neurosciences, Stroke Service, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK
| | - D Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - P Michel
- Stroke Centre, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Brown MD, Burton JH, Nazarian DJ, Promes SB. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med 2016; 66:322-333.e31. [PMID: 26304253 DOI: 10.1016/j.annemergmed.2015.06.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Murphy SN, Herrick C, Wang Y, Wang TD, Sack D, Andriole KP, Wei J, Reynolds N, Plesniak W, Rosen BR, Pieper S, Gollub RL. High throughput tools to access images from clinical archives for research. J Digit Imaging 2016; 28:194-204. [PMID: 25316195 PMCID: PMC4359193 DOI: 10.1007/s10278-014-9733-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Historically, medical images collected in the course of clinical care have been difficult to access for secondary research studies. While there is a tremendous potential value in the large volume of studies contained in clinical image archives, Picture Archiving and Communication Systems (PACS) are designed to optimize clinical operations and workflow. Search capabilities in PACS are basic, limiting their use for population studies, and duplication of archives for research is costly. To address this need, we augment the Informatics for Integrating Biology and the Bedside (i2b2) open source software, providing investigators with the tools necessary to query and integrate medical record and clinical research data. Over 100 healthcare institutions have installed this suite of software tools that allows investigators to search medical record metadata including images for specific types of patients. In this report, we describe a new Medical Imaging Informatics Bench to Bedside (mi2b2) module (www.mi2b2.org), available now as an open source addition to the i2b2 software platform that allows medical imaging examinations collected during routine clinical care to be made available to translational investigators directly from their institution’s clinical PACS for research and educational use in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule. Access governance within the mi2b2 module is customizable per institution and PACS minimizing impact on clinical systems. Currently in active use at our institutions, this new technology has already been used to facilitate access to thousands of clinical MRI brain studies representing specific patient phenotypes for use in research.
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Affiliation(s)
- Shawn N Murphy
- Research IS and Computing, Partners HealthCare, Charlestown, MA, 02129, USA,
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Turc G, Sallem A, Moulin S, Tisserand M, Machet A, Edjlali M, Baron JC, Leclerc X, Leys D, Mas JL, Cordonnier C, Oppenheim C. Microbleed Status and 3-Month Outcome After Intravenous Thrombolysis in 717 Patients With Acute Ischemic Stroke. Stroke 2015; 46:2458-63. [DOI: 10.1161/strokeaha.115.009290] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/13/2015] [Indexed: 12/22/2022]
Abstract
Background and Purpose—
Whether cerebral microbleeds (CMBs) detected on pretreatment magnetic resonance imaging increase the risks of symptomatic intracranial hemorrhage (sICH) and, most importantly, poor outcome in patients treated by intravenous thrombolysis for acute ischemic stroke is still debated. We assessed the effect of CMB presence and burden on 3-month modified Rankin Scale and sICH in a multicentric cohort.
Methods—
We analyzed prospectively collected data of consecutive patients solely treated by intravenous thrombolysis for acute ischemic stroke, in 2 centers where magnetic resonance imaging is the first-line pretreatment imaging. Neuroradiologists blinded to clinical data rated CMBs on T2* sequence using a validated scale. Logistic regressions were used to assess relationships between CMBs and 3-month modified Rankin Scale or sICH.
Results—
Among 717 patients, 150 (20.9%) had ≥1 CMBs. CMB burden was associated with worse modified Rankin Scale in univariable shift analysis (odds ratio, 1.07; 95% confidence interval, 1.00–1.15 per 1-CMB increase;
P
=0.049), but significance was lost after adjustment for age, hypertension, and atrial fibrillation (odds ratio, 1.03; 95% confidence interval, 0.96–1.11 per 1-CMB increase;
P
=0.37). Results remained nonsignificant when taking into account CMB location or presumed underlying vasculopathy. The incidence of sICH ranged from 3.8% to 9.1%, depending on the definition. Neither CMB presence, burden, location, nor presumed underlying vasculopathy was independently associated with sICH.
Conclusions—
Poor outcome or sICH was not associated with CMB presence or burden on pre–intravenous thrombolysis magnetic resonance imaging after adjustment for confounding factors. An individual patient data meta-analysis is needed to determine whether a subgroup of patients with CMBs carries an independent risk of poor outcome that might outweigh the expected benefit of intravenous thrombolysis.
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Affiliation(s)
- Guillaume Turc
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Asmaa Sallem
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Solène Moulin
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Marie Tisserand
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Alexandre Machet
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Myriam Edjlali
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Jean-Claude Baron
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Xavier Leclerc
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Didier Leys
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Jean-Louis Mas
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Charlotte Cordonnier
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
| | - Catherine Oppenheim
- From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France
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Bourcier R, Volpi S, Guyomarch B, Daumas-Duport B, Lintia-Gaultier A, Papagiannaki C, Serfaty JM, Desal H. Susceptibility Vessel Sign on MRI Predicts Favorable Clinical Outcome in Patients with Anterior Circulation Acute Stroke Treated with Mechanical Thrombectomy. AJNR Am J Neuroradiol 2015; 36:2346-53. [PMID: 26316570 DOI: 10.3174/ajnr.a4483] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/18/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The susceptibility vessel sign on MR imaging has been reported to indicate acute occlusion from erythrocyte-rich thrombus. The purpose of this study was to evaluate the influence of the susceptibility vessel sign seen on MR imaging before treatment on the clinical outcome after mechanical thrombectomy for anterior circulation acute stroke. MATERIALS AND METHODS We retrospectively included 73 consecutive patients who were treated for anterior circulation acute stroke by mechanical thrombectomy from December 2009 to September 2013. Each patient underwent MR imaging before mechanical thrombectomy. The presence (susceptibility vessel sign+) or absence of the susceptibility vessel sign (susceptibility vessel sign-) was recorded. Mechanical thrombectomy was performed either alone or in association with IV tPA according to the site and time after occlusion. Good functional outcome was defined by an mRS ≤ 2 at 3 months in susceptibility vessel sign+ and susceptibility vessel sign- groups. Patient clinical characteristics, initial NIHSS score and ASPECTS, site of occlusion, time between onset to groin puncture, TICI after mechanical thrombectomy, NIHSS score at day 1, and spontaneous hyperattenuation on CT at day 1 were also analyzed. RESULTS Fifty-three patients with susceptibility vessel sign+ and 20 with susceptibility vessel sign- were included in our study. mRS ≤ 2 at 3 months occurred in 65% patients in the susceptibility vessel sign+ group and 26% in the susceptibility vessel sign- group (P = .004). On multivariate analysis, the susceptibility vessel sign was the only parameter before treatment that could predict mRS ≤ 2 at 3 months (OR, 8.7; 95% CI, 1.1-69.4; P = .04). CONCLUSIONS Our study strongly suggests that the susceptibility vessel sign on MR imaging before treatment is predictive of favorable clinical outcome for patients presenting with anterior circulation acute stroke and treated with mechanical thrombectomy.
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Affiliation(s)
- R Bourcier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - S Volpi
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - B Guyomarch
- Centre d'investigation clinique Thorax (B.G.), l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France Centre national de la recherche scientifique (B.G,), UMR 6291, Nantes, France
| | - B Daumas-Duport
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - A Lintia-Gaultier
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.)
| | - C Papagiannaki
- Department of Diagnostic and Interventional Neuroradiology (C.P.), Centre Hospitalier Régional Universitaire de Tours, Bretonneau Hospital, Tours, France
| | - J M Serfaty
- Diagnostic Cardiac and Vascular Imaging (J.M.S.), Centre Hospitalier Universitaire Nantes Hôpital G et R Laënnec, Nantes, France Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
| | - H Desal
- From the Departments of Diagnostic and Interventional Neuroradiology (R.B., S.V., B.D.-D., A.L.-G., H.D.) Institut National de la Santé et de la Recherche Médicale, UMR1087 (B.G., J.M.S., H.D.), l'institut du thorax, Nantes, France
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Tansy AP, Hinman JD, Ng KL, Calderon-Arnulphi M, Modir R, Chatfield F, Liebeskind DS. Image More to Save More. Front Neurol 2015. [PMID: 26217302 PMCID: PMC4499705 DOI: 10.3389/fneur.2015.00156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent successful endovascular stroke trials have provided unequivocal support for these therapies in selected patients with large-vessel occlusive acute ischemic stroke. In this piece, we briefly review these trials and their utilization of advanced neuroimaging techniques that played a pivotal role in their success through targeted patient selection. In this context, the unique challenges and opportunity for advancement in current stroke networks' routine delivery of care created by these trials are discussed and recommendations to change current national stroke system guidelines are proposed.
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Affiliation(s)
- Aaron P Tansy
- Department of Neurology, Mount Sinai Comprehensive Stroke Center , New York, NY , USA
| | - Jason D Hinman
- University of California Los Angeles Comprehensive Stroke Center , Los Angeles, CA , USA
| | - Kwan L Ng
- University of California Los Angeles Comprehensive Stroke Center , Los Angeles, CA , USA
| | | | - Royya Modir
- University of California San Diego Comprehensive Stroke Center , San Diego, CA , USA
| | - Fiona Chatfield
- University of California Los Angeles Comprehensive Stroke Center , Los Angeles, CA , USA
| | - David S Liebeskind
- University of California Los Angeles Comprehensive Stroke Center , Los Angeles, CA , USA
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Lee JS, Kim CK, Kang J, Park JM, Park TH, Lee KB, Lee SJ, Cho YJ, Ko J, Seo J, Bae HJ, Lee J. A Novel Computerized Clinical Decision Support System for Treating Thrombolysis in Patients with Acute Ischemic Stroke. J Stroke 2015; 17:199-209. [PMID: 26060807 PMCID: PMC4460339 DOI: 10.5853/jos.2015.17.2.199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Thrombolysis is underused in acute ischemic stroke, mainly due to the reluctance of physicians to treat thrombolysis patients. However, a computerized clinical decision support system can help physicians to develop individualized stroke treatments. METHODS A consecutive series of 958 patients, hospitalized within 12 hours of ischemic stroke onset from a representative clinical center in Korea, was used to establish a prognostic model. Multivariable logistic regression was used to develop the model for global and safety outcomes. An external validation of developed model was performed using 954 patients data obtained from 5 university hospitals or regional stroke centers. RESULTS Final global outcome predictors were age; previous modified Rankin scale score; initial National Institutes of Health Stroke Scale (NIHSS) score; previous stroke; diabetes; prior use of antiplatelet treatment, antihypertensive drugs, and statins; lacunae; thrombolysis; onset to treatment time; and systolic blood pressure. Final safety outcome predictors were age, initial NIHSS score, thrombolysis, onset to treatment time, systolic blood pressure, and glucose level. The discriminative ability of the prognostic model showed a C-statistic of 0.89 and 0.84 for the global and safety outcomes, respectively. Internal and external validation showed similar C-statistic results. After updating the model, calibration slopes were corrected from 0.68 to 1.0 and from 0.96 to 1.0 for the global and safety outcome models, respectively. CONCLUSIONS A novel computerized outcome prediction model for thrombolysis after ischemic stroke was developed using large amounts of clinical information. After external validation and updating, the model's performance was deemed clinically satisfactory.
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Affiliation(s)
- Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jihoon Kang
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Jaehee Ko
- Human-Computer Interaction Lab, Department of Computer Science and Engineering, Seoul National University, Seoul, Korea
| | - Jinwook Seo
- Human-Computer Interaction Lab, Department of Computer Science and Engineering, Seoul National University, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
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Ntaios G, Papavasileiou V, Michel P, Tatlisumak T, Strbian D. Predicting functional outcome and symptomatic intracranial hemorrhage in patients with acute ischemic stroke: a glimpse into the crystal ball? Stroke 2015; 46:899-908. [PMID: 25657189 DOI: 10.1161/strokeaha.114.003665] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George Ntaios
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Vasileios Papavasileiou
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Patrik Michel
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Turgut Tatlisumak
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Daniel Strbian
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.).
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Abstract
Intravenous thrombolysis (IVT) with alteplase remains the standard treatment for acute ischemic stroke. Although IVT can be started up to 4.5 hours after symptoms' onset, it is all the more effective and safe when started early. It allows a 10% absolute reduction in the risk of handicap or death at 3 months, despite a 2-7% risk of symptomatic intracranial hemorrhage. Current research efforts involve firstly trying to treat a larger proportion of patients by overcoming some of the contraindications to IVT and secondly assessing combined or alternative treatments to achieve a higher early recanalization rate.
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Affiliation(s)
- G Turc
- Stroke unit, Sainte-Anne hospital, 1, rue Cabanis, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; Inserm UMR S894, France.
| | - C Isabel
- Stroke unit, Sainte-Anne hospital, 1, rue Cabanis, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France
| | - D Calvet
- Stroke unit, Sainte-Anne hospital, 1, rue Cabanis, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; Inserm UMR S894, France
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Inoue M, Olivot JM, Labreuche J, Mlynash M, Tai W, Albucher JF, Meseguer E, Amarenco P, Mazighi M. Impact of diffusion-weighted imaging Alberta stroke program early computed tomography score on the success of endovascular reperfusion therapy. Stroke 2014; 45:1992-8. [PMID: 24923724 DOI: 10.1161/strokeaha.114.005084] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization. METHODS We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic stroke patients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days. RESULTS Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001). CONCLUSIONS DWI-ASPECTS≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved.
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Affiliation(s)
- Manabu Inoue
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Jean-Marc Olivot
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Julien Labreuche
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Michael Mlynash
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Waimea Tai
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Jean-François Albucher
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Elena Meseguer
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Pierre Amarenco
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.)
| | - Mikael Mazighi
- From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.).
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External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis. PLoS One 2014; 9:e99164. [PMID: 24896827 PMCID: PMC4045936 DOI: 10.1371/journal.pone.0099164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose The aim of our study was to validate in an independent cohort the MRI-DRAGON score, an adaptation of the (CT-) DRAGON score to predict 3-month outcome in acute ischemic stroke patients undergoing MRI before intravenous thrombolysis (IV-tPA). Methods We reviewed consecutive (2009–2013) anterior circulation stroke patients treated within 4.5 hours by IV-tPA in the Lille stroke unit (France), where MRI is the first-line pretherapeutic work-up. We assessed the discrimination and calibration of the MRI-DRAGON score to predict poor 3-month outcome, defined as modified Rankin Score >2, using c-statistic and the Hosmer-Lemeshow test, respectively. Results We included 230 patients (mean ±SD age 70.4±16.0 years, median [IQR] baseline NIHSS 8 [5]–[14]; poor outcome in 78(34%) patients). The c-statistic was 0.81 (95%CI 0.75–0.87), and the Hosmer-Lemeshow test was not significant (p = 0.54). Conclusions The MRI-DRAGON score showed good prognostic performance in the external validation cohort. It could therefore be used to inform the patient's relatives about long-term prognosis and help to identify poor responders to IV-tPA alone, who may be candidates for additional therapeutic strategies, if they are otherwise eligible for such procedures based on the institutional criteria.
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Heiss WD, Kidwell CS. Imaging for prediction of functional outcome and assessment of recovery in ischemic stroke. Stroke 2014; 45:1195-201. [PMID: 24595589 DOI: 10.1161/strokeaha.113.003611] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Wolf-Dieter Heiss
- From the Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.); and Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.)
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Strbian D, Michel P, Seiffge DJ, Saver JL, Numminen H, Meretoja A, Murao K, Weder B, Forss N, Parkkila AK, Eskandari A, Cordonnier C, Davis SM, Engelter ST, Tatlisumak T. Symptomatic Intracranial Hemorrhage After Stroke Thrombolysis. Stroke 2014; 45:752-8. [DOI: 10.1161/strokeaha.113.003806] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Strbian
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Patrik Michel
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - David J. Seiffge
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Jeffrey L. Saver
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Heikki Numminen
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Atte Meretoja
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Kei Murao
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Bruno Weder
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Nina Forss
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Anna-Kaisa Parkkila
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Ashraf Eskandari
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Charlotte Cordonnier
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Stephen M. Davis
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Stefan T. Engelter
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
| | - Turgut Tatlisumak
- From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., N.F., T.T.); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); University Hospital Basel, Basel, Switzerland (D.J.S., S.T.E.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (J.L.S.); Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); The Royal Melbourne Hospital, Parkville,
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Apoil M, Turc G, Tisserand M, Calvet D, Naggara O, Domigo V, Baron JC, Oppenheim C, Touzé E. Clinical and magnetic resonance imaging predictors of very early neurological response to intravenous thrombolysis in patients with middle cerebral artery occlusion. J Am Heart Assoc 2013; 2:e000511. [PMID: 24308937 PMCID: PMC3886747 DOI: 10.1161/jaha.113.000511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The early identification of patients who are unlikely to respond to intravenous recombinant tissue plasminogen activator (IV‐tPA) could help select candidates for additional intra‐arterial therapy or add‐on antithrombotic drugs during the acute stage of stroke. Given that very early neurological improvement (VENI) is a reliable surrogate of early recanalization, we assessed the clinical and magnetic resonance imaging predictors of lack of VENI. Methods and Results We reviewed consecutive ischemic stroke patients with middle cerebral artery occlusion and treated within 4.5 hours by IV‐tPA between 2003 and 2012 in our center, where magnetic resonance imaging is systematically implemented as first‐line diagnostic workup. Lack of VENI was defined as a <40% decrease in baseline National Institutes of Health Stroke Scale (NIHSS) score 1 hour after start of IV‐tPA. Poor outcome was defined as a 3‐month modified Rankin scale ≥2. Associations between lack of VENI and potential determinants were assessed in logistic regression models. In all, 186 patients were included (median baseline NIHSS score, 16; median onset to treatment time, 155 minutes). One hundred forty‐three patients (77%) had no VENI. The variables significantly associated with lack of VENI in multivariable analysis were baseline NIHSS (OR, 1.08; 95% CI, 1.01 to 1.16 per 1‐point increase; P=0.03), onset to treatment time >120 minutes (OR, 2.94; 95% CI, 1.31 to 6.63; P=0.009) and diffusion weighted imaging—Alberta Stroke Programme Early CT Score ≤5 (OR, 3.60; 95% CI, 1.14 to 11.35; P=0.03). Patients without VENI were more likely to have a modified Rankin Scale ≥2 than those without VENI (68% versus 24%; OR, 5.01; 95% CI, 2.12 to 11.82) and less likely to have recanalization after 24 hours (OR, 0.41; 95% CI, 0.19 to 0.88). Conclusions Lack of VENI provides an early estimate of 3‐month outcome and recanalization after IV‐tPA. Baseline NIHSS, onset to treatment time, and diffusion weighted imaging—Alberta Stroke Programme Early CT Score could help to predict lack of VENI and, in turn, might help early selection of candidates for complementary reperfusion strategies.
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Affiliation(s)
- Marion Apoil
- Université Paris Descartes Sorbonne Paris Cité, INSERM UMR S894, Hôpital Sainte-Anne, Paris, France
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de Margerie-Mellon C, Turc G, Tisserand M, Naggara O, Calvet D, Legrand L, Meder JF, Mas JL, Baron JC, Oppenheim C. Can DWI-ASPECTS Substitute for Lesion Volume in Acute Stroke? Stroke 2013; 44:3565-7. [PMID: 24092549 DOI: 10.1161/strokeaha.113.003047] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The extent of diffusion lesion on pretreatment imaging is a risk factor for poor outcome and hemorrhagic transformation after thrombolysis, and volumes of 70 to 100 mL have been advocated as cut-offs. However, estimating diffusion-weighted imaging (DWI) lesion volume (Vol
DWI
) in the acute setting may be cumbersome. We aimed to determine whether the DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) can substitute for Vol
DWI
.
Methods—
DWI-ASPECTS and Vol
DWI
were measured retrospectively on pretreatment MRI (median onset-to-MRI delay=122 minutes) in 330 consecutively treated patients with middle cerebral artery stroke.
Results—
DWI-ASPECTS and Vol
DWI
were strongly correlated (ρ=−0.82), but each DWI-ASPECTS point corresponded to a wide range of Vol
DWI
. All patients with DWI-ASPECTS ≥7 (n=207) had Vol
DWI
<70 mL, whereas 32 of the 34 patients with DWI-ASPECTS <4 had Vol
DWI
>100 mL. However, intermediate DWI-ASPECTS (4–6; n=89) corresponded to highly variable Vol
DWI
(median, 66 mL; interquartile range, 40–98).
Conclusions—
Although each DWI-ASPECTS point corresponds to a wide range of volumes, DWI-ASPECTS <4 or ≥7 may be used as reliable surrogates of Vol
DWI
>100 or <70 mL, respectively.
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Affiliation(s)
- Constance de Margerie-Mellon
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Marie Tisserand
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - David Calvet
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jean-François Meder
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France
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Naggara O, Raymond J, Domingo Ayllon M, Al-Shareef F, Touzé E, Chenoufi M, Gerber S, Mellerio C, Zuber M, Meder JF, Mas JL, Oppenheim C. T2* "susceptibility vessel sign" demonstrates clot location and length in acute ischemic stroke. PLoS One 2013; 8:e76727. [PMID: 24146915 PMCID: PMC3795632 DOI: 10.1371/journal.pone.0076727] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of our study was to evaluate, in acute ischemic stroke patients, the diagnostic accuracy of the MRI susceptibility vessel sign (SVS) against catheter angiography (DSA) for the detection of the clot and its value in predicting clot location and length. MATERIALS AND METHODS We identified consecutive patients (2006-2012) admitted to our center, where 1.5 T MRI is systematically implemented as first-line diagnostic work-up, with: (1) pre-treatment 6-mm-thick multislice 2D T2* sequence; (2) delay from MRI-to-DSA <3 hrs; (3) no fibrinolysis between MRI and DSA. The location and length of SVS on T2* was independently assessed by three readers, and compared per patient, per artery and per segment, to DSA findings, obtained by two different readers. Clot length measured on T2* and DSA were compared using intra-class correlation coefficient (ICC), Bland & Altman test and Passing & Bablok regression analysis. RESULTS On DSA, a clot was present in 85 patients, in 126 of 1190 (10.6%) arteries and 175 of 1870 (9.4%) segments. Sensitivity of the SVS, as sensed by the used protocol at 1.5 T, was 81.1% (69 of 85 patients) and was higher in anterior (55 of 63, 87.3%), than in posterior circulation stroke (14 of 22, 63.6%, p=0.02). Sensitivity/specificity was 69.8/99.6% (per artery) and 76.6/99.7% (per segment). Positive (PPV) and negative predictive value (NPV) and accuracy were all >94%. Inter- and intra-observer ICC was excellent for clot length as measured on T2* (ĸ ≥ 0.97) and as measured on DSA (ĸ ≥ 0.94). Correlation between T2* and DSA for clot length was excellent (ICC: 0.88, 95%CI: 0.81-0.92; Bland & Altman: mean bias of 1.6% [95%CI: -4.7 to 7.8%], Passing & Bablok: 0.91). CONCLUSIONS SVS is a specific marker of clot location in the anterior and posterior circulation. Clot length greater than 6 mm can be reliably measured on T2*.
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Affiliation(s)
- Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
- * E-mail:
| | - Jean Raymond
- Department of Radiology, The International Consortium of Neuroendovascular Centres, Interventional Neuroradiology Research Unit, University of Montreal, Notre-Dame Hospital, Montreal, QC, Canada
| | - Montserrat Domingo Ayllon
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Fawaz Al-Shareef
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Emmanuel Touzé
- Department of Neurology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Meriem Chenoufi
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Sophie Gerber
- Department of Radiology, Saint Joseph Hospital, Paris, France
| | - Charles Mellerio
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Matthieu Zuber
- Department of Neurology, Saint Joseph Hospital, Paris, Ile de France, France
| | - Jean Francois Meder
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Jean-Louis Mas
- Department of Neurology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, Ile de France, France
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Strbian D, Seiffge DJ, Breuer L, Numminen H, Michel P, Meretoja A, Coote S, Bordet R, Obach V, Weder B, Jung S, Caso V, Curtze S, Ollikainen J, Lyrer PA, Eskandari A, Mattle HP, Chamorro A, Leys D, Bladin C, Davis SM, Köhrmann M, Engelter ST, Tatlisumak T. Validation of the DRAGON Score in 12 Stroke Centers in Anterior and Posterior Circulation. Stroke 2013; 44:2718-21. [DOI: 10.1161/strokeaha.113.002033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation.
Methods—
Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0–2) and miserable (modified Rankin scale score, 5–6) outcomes.
Results—
Area under the receiver operating characteristic curve was 0.84 (0.82–0.85) for miserable outcome and 0.82 (0.80–0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (
P
=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83–0.86) and 0.82 (0.78–0.87), respectively. No sex-related difference in performance was observed (
P
=0.25).
Conclusions—
The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).
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Affiliation(s)
- Daniel Strbian
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - David J. Seiffge
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Lorenz Breuer
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Heikki Numminen
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Patrik Michel
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Atte Meretoja
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Skye Coote
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Régis Bordet
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Victor Obach
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Bruno Weder
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Simon Jung
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Valeria Caso
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Sami Curtze
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Jyrki Ollikainen
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Philippe A. Lyrer
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Ashraf Eskandari
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Heinrich P. Mattle
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Angel Chamorro
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Didier Leys
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Christopher Bladin
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Stephen M. Davis
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Martin Köhrmann
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Stefan T. Engelter
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
| | - Turgut Tatlisumak
- From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne,
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Aoki J, Kimura K, Shibazaki K, Sakamoto Y, Saji N, Uemura J. Location of the Susceptibility Vessel Sign on T2*-Weighted MRI and Early Recanalization within 1 Hour after Tissue Plasminogen Activator Administration. Cerebrovasc Dis Extra 2013; 3:111-20. [PMID: 24163686 PMCID: PMC3806703 DOI: 10.1159/000354848] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background We have recently reported that the susceptibility vessel sign (SVS) at the proximal portion of the horizontal (M1) middle cerebral artery (MCA) on T2*-weighted MRI is a strong predictor for no early recanalization after intravenous recombinant tissue plasminogen activator (t-PA) therapy. However, it is unclear whether the presence of the SVS at other locations, such as distal M1, the vertical portion (M2) of the MCA, and distal branches (MCA distal), is a predictor for no early recanalization in acute ischemic stroke patients. Methods The SVS was defined as a hypointense signal of the MCA on T2*-weighted MRI on admission. The locations of the SVS were classified as M1 proximal, M1 distal, and MCA distal. M1 proximal SVS was defined as an SVS at the origin of the M1. M1 distal SVS was any M1 SVS not including the origin of the M1. MCA distal SVS was an SVS further away from M1. Early recanalization was defined as a new appearance of at least one of the distal branches on MRA within 1 h after t-PA therapy. A good outcome at 3 months was defined as a modified Rankin Scale (mRS) score of 0-1. Results Consecutive acute stroke patients admitted to our stroke center and treated with t-PA between October 2005 and October 2012 were enrolled. There were 158 patients [median age, 78 (71-84) years; 84 (53%) males; median National Institutes of Health Stroke Scale score, 16 (10-20)]. Internal carotid artery occlusion was seen in 18 (72%) of the 25 patients with M1 proximal SVS, in 3 (14%) of the 22 patients with M1 distal SVS, in 4 (9%) of the 44 patients with MCA distal SVS, and in 18 (27%) of the 67 patients with No SVS (p < 0.001). Twenty-four (96%) of the 25 patients with M1 proximal SVS had no early recanalization, while 16 (73%) of the 22 patients with M1 distal SVS, 25 (57%) of the 44 patients with MCA distal SVS, and 36 (54%) of the 67 patients with No SVS had no early recanalization (p < 0.001, 0.140, and 0.846, respectively, compared to the patients with No SVS). Multivariate analysis showed that only M1 proximal SVS was significantly associated with no early recanalization (odds ratio 16.80, 95% confidence interval 2.04-138.17, p = 0.009). Among the 95 patients with a premorbid mRS score of 0-1, none (0%) of the 16 patients with M1 proximal SVS, 5 (36%) of the 14 patients with M1 distal SVS, 12 (48%) of the 25 patients with MCA distal SVS, and 13 (33%) of the 40 patients with No SVS achieved a good outcome (p = 0.011, 1.000, and 0.295, respectively, compared to the patients with No SVS). Conclusion M1 proximal SVS on T2*-weighted MRI is a strong predictor for no early recanalization, and all patients with it had a poor outcome. However, M1 distal SVS and MCA distal SVS were not predictors for no early recanalization, and half of the patients had a poor outcome.
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Affiliation(s)
- Junya Aoki
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan
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Giralt-Steinhauer E, Rodríguez-Campello A, Cuadrado-Godia E, Ois Á, Jiménez-Conde J, Soriano-Tárraga C, Roquer J. External validation of the DRAGON score in an elderly Spanish population: prediction of stroke prognosis after IV thrombolysis. Cerebrovasc Dis 2013; 36:110-4. [PMID: 24029547 DOI: 10.1159/000352061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intravenous (i.v.) thrombolysis within 4.5 h of symptom onset has proven efficacy in acute ischemic stroke treatment, although half of all outcomes are unfavorable. The recently published DRAGON score aims to predict the 3-month outcome in stroke patients who have received i.v. alteplase. The purpose of this study was an external validation of the results of the DRAGON score in a Spanish cohort. METHODS Patients with acute stroke treated with alteplase were prospectively registered in our BasicMar database. We collected demographic characteristics, vascular risk factors, the time from stroke onset to treatment, baseline serum glucose levels and stroke severity for this population. We then reviewed hyperdense cerebral artery signs and signs of early infarct on the admission CT scan. We calculated the DRAGON score and used the developers' 3-month prognosis categories: good [modified Rankin Scale score (mRS) 0-2], poor (mRS 3-6) and miserable (mRS 5-6) outcome. Discrimination was tested using the area under the receiver operator curve (AUC-ROC). Calibration was assessed by the Hosmer-Lemeshow test. RESULTS Our final cohort of 297 patients was older (median age 74 years, IQR 65-80) and had more risk factors and severe strokes [median National Institutes of Health Stroke Scale (NIHSS) points 13, IQR 7-19] than the original study population. Poor prognosis was observed in 143 (48.1%) patients. Higher DRAGON scores were associated with a higher risk of poor prognosis. None of our treated stroke patients with a DRAGON score ≥8 at admission experienced a favorable outcome after 3 months. All DRAGON variables were significantly associated with a worse outcome in the multivariate analysis except for onset-to-treatment time (p = 0.334). Discrimination to predict poor prognosis was very good (AUC-ROC 0.84) and the score had good Hosmer-Lemeshow calibration (p = 0.84). CONCLUSIONS The DRAGON score is easy to perform and offers a rapid, reliable prediction of poor prognosis in acute-stroke patients treated with alteplase. This study replicates the original results in a different population.
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