Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/11474
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dc.contributor.authorNagakane, Yoshinarien
dc.contributor.authorChristensen, Sorenen
dc.contributor.authorOgata, Toshiyasuen
dc.contributor.authorChurilov, Leoniden
dc.contributor.authorMa, Henry Ken
dc.contributor.authorParsons, Mark Wen
dc.contributor.authorDesmond, Patricia Men
dc.contributor.authorLevi, Christopher Ren
dc.contributor.authorButcher, Kenneth Sen
dc.contributor.authorDavis, Stephen Men
dc.contributor.authorDonnan, Geoffrey Aen
dc.date.accessioned2015-05-16T01:05:10Z
dc.date.available2015-05-16T01:05:10Z
dc.date.issued2012-04-12en
dc.identifier.citationStroke; A Journal of Cerebral Circulation 2012; 43(6): 1548-55en
dc.identifier.govdoc22499579en
dc.identifier.otherPUBMEDen
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/11474en
dc.description.abstractThe mismatch lesion volumes defined by perfusion-weighted imaging exceeding diffusion-weighted imaging have been used as a marker of ischemic penumbral tissue. Defining the perfusion lesion by thresholding has shown promise as a practical tool; several positron emission tomography studies have indicated a more probabilistic relationship between perfusion and infarction. Here, we used a randomized controlled trial dataset of tissue-type plasminogen activator 3 to 6 hours after stroke to: (1) quantify the relationship between severity of hypoperfusion (measured by Tmax) and risk of infarction; (2) exploit this relationship to present a novel definition of mismatch based on infarct probabilities rather than dichotomies; and (3) examine the treatment response in the subgroup of patients with mismatch by the new definition.Patients from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) were included. Baseline perfusion-weighted imaging and 90-day T2-weighted imaging were coregistered. Perfusion-weighted imaging lesion volumes were divided into 10 Tmax delay strata, and infarct risk was defined as the fraction of the tissue at a given Tmax strata that progressed to infarction by day 90.Sixty-two patients were studied. Infarct risk was an increasing function of Tmax for all subgroups, including the whole cohort. The probabilistic approach outperformed all Tmax thresholds, with exception of the Tmax ≥ 10 threshold, for which it was only favored by a trend.Infarct risk and treatment effect increased with severity of perfusion abnormalities. This suggests that a severity-weighted mismatch definition may define penumbral tissue more accurately.en
dc.language.isoenen
dc.subject.otherAdulten
dc.subject.otherAgeden
dc.subject.otherAged, 80 and overen
dc.subject.otherCerebral Infarction.diagnosis.etiology.physiopathologyen
dc.subject.otherFemaleen
dc.subject.otherFibrinolytic Agents.administration & dosageen
dc.subject.otherHumansen
dc.subject.otherMagnetic Resonance Angiographyen
dc.subject.otherMaleen
dc.subject.otherMiddle Ageden
dc.subject.otherPositron-Emission Tomographyen
dc.subject.otherRisk Factorsen
dc.subject.otherStroke.complications.diagnosis.drug therapy.physiopathologyen
dc.subject.otherTime Factorsen
dc.subject.otherTissue Plasminogen Activator.administration & dosageen
dc.titleMoving beyond a single perfusion threshold to define penumbra: a novel probabilistic mismatch definition.en
dc.typeJournal Articleen
dc.identifier.journaltitleStrokeen
dc.identifier.affiliationNational Stroke Research Institute, Florey Neuroscience Institutes, Austin Health, University of Melbourne, Victoria 3053, Australiaen
dc.identifier.doi10.1161/STROKEAHA.111.643932en
dc.description.pages1548-55en
dc.relation.urlhttps://pubmed.ncbi.nlm.nih.gov/22499579en
dc.contributor.corpauthorEPITHET Investigatorsen
dc.type.austinJournal Articleen
local.name.researcherChurilov, Leonid
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.languageiso639-1en-
item.openairetypeJournal Article-
crisitem.author.deptMedicine (University of Melbourne)-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
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