Computed tomography–based quantification of lesion water uptake identifies patients within 4.5 hours of stroke onset: A multicenter observational study
- 7 November 2016
- journal article
- research article
- Published by Wiley in Annals of Neurology
- Vol. 80 (6), 924-934
- https://doi.org/10.1002/ana.24818
Abstract
Objective Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether computed tomography (CT)‐based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours, the time window of thrombolysis. Methods Perfusion CT was used to identify ischemic brain tissue, and its density was measured in native CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. The optimal cutoff value of water uptake distinguishing stroke onset within and beyond 4.5 hours was calculated in patients with proximal middle cerebral artery occlusion (derivation cohort) with known time of symptom onset. The so‐derived cutoff value was validated in a prospective cohort from other stroke centers. Results Of 178 patients of the derivation cohort, 147 (82.6%) had CT within 4.5 hours. Percentage water uptake was significantly lower in patients with stroke onset within compared to beyond 4.5 hours. The area under the receiver operating characteristic curve for distinguishing these patient groups according to percentage water uptake was 0.999 (95% confidence interval = 0.996–1.000, p < 0.001) with an optimal cutoff value of 11.5%. Applying this cutoff to the validation cohort of 240 patients, sensitivity was 98.6%, specificity 90.5%, positive predictive value 99.1%, and negative predictive value 86.4%. Interpretation Quantification of brain water uptake identifies stroke patients with symptom onset within 4.5 hours with high accuracy and may guide the decision to use thrombolysis in patients with unknown time of stroke onset. Ann Neurol 2016;80:924–934Keywords
Funding Information
- Else Kröner-Fresenius Foundation (2014_EKES.16)
This publication has 25 references indexed in Scilit:
- Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic StrokeJAMA, 2013
- A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial to Test Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-up Stroke (WAKE-UP)International Journal of Stroke, 2013
- MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort studyThe Lancet Neurology, 2012
- Negative fluid‐attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or lessAnnals of Neurology, 2009
- Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trialThe Lancet Neurology, 2008
- Ischemic Brain Tissue Water Content: CT Monitoring during Middle Cerebral Artery Occlusion and Reperfusion in Rats1Radiology, 2007
- Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) studyAnnals of Neurology, 2006
- Correlation of Apparent Diffusion Coefficient and Computed Tomography Density in Acute Ischemic StrokeStroke, 2002
- The Stroke Patient Who Woke UpStroke, 2002
- Experimental regional cerebral ischemia in the middle cerebral artery territory in primates. Part 2: Effects on brain water and electrolytes in the early phase of MCA stroke.Stroke, 1977