Simplified Assessment of Lesion Water Uptake for Identification of Patients within 4.5 Hours of StrokeOnset: An Analysis of the MissPerfeCT Study
- Author:
Peter B. SPORNS
1
;
Marco HÖHNE
;
Lennart MEYER
;
Christos KROGIAS
;
Volker PUETZ
;
Kolja M. THIERFELDER
;
Marco DUERING
;
Daniel KAISER
;
Sönke LANGNER
;
Alex BREHM
;
Lukas T. ROTKOPF
;
Wolfgang G. KUNZ
;
Jens FIEHLER
;
Walter HEINDEL
;
Peter SCHRAMM
;
Heinz WIENDL
;
Heike MINNERUP
;
Marios Nikos PSYCHOGIOS
;
André KEMMLING
;
Jens MINNERUP
Author Information
- Publication Type:Original Article
- From:Journal of Stroke 2022;24(3):390-395
- CountryRepublic of Korea
- Language:English
- Abstract: and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
