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Title: Automated DWI analysis can identify patients within the thrombolysis time window of 4.5 hours.
Authors: Wouters, Anke;Cheng, Bastian;Christensen, Soren;Dupont, Patrick;Robben, David;Norrving, Bo;Laage, Rico;Thijs, Vincent N;Albers, Gregory W;Thomalla, Götz;Lemmens, Robin
Affiliation: The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA, USA
Department of Neurology, Lund University, Sweden
Guided Development GmbH, Heidelberg, Germany
Departments of Neurosciences, Cognitive Neurology, and Electrical Engineering, KU Leuven, University of Leuven, Leuven, Belgium
VIB Center for Brain & Disease Research, Leuven, Belgium
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Issue Date: 1-May-2018
EDate: 2018-05-01
Citation: Neurology 2018; 90(18): e1570-e1577
Abstract: To develop an automated model based on diffusion-weighted imaging (DWI) to detect patients within 4.5 hours after stroke onset and compare this method to the visual DWI-FLAIR (fluid-attenuated inversion recovery) mismatch. We performed a subanalysis of the "DWI-FLAIR mismatch for the identification of patients with acute ischemic stroke within 4.5 hours of symptom onset" (PRE-FLAIR) and the "AX200 for ischemic stroke" (AXIS 2) trials. We developed a prediction model with data from the PRE-FLAIR study by backward logistic regression with the 4.5-hour time window as dependent variable and the following explanatory variables: age and median relative DWI (rDWI) signal intensity, interquartile range (IQR) rDWI signal intensity, and volume of the core. We obtained the accuracy of the model to predict the 4.5-hour time window and validated our findings in an independent cohort from the AXIS 2 trial. We compared the receiver operating characteristic curve to the visual DWI-FLAIR mismatch. In the derivation cohort of 118 patients, we retained the IQR rDWI as explanatory variable. A threshold of 0.39 was most optimal in selecting patients within 4.5 hours after stroke onset resulting in a sensitivity of 76% and specificity of 63%. The accuracy was validated in an independent cohort of 200 patients. The predictive value of the area under the curve of 0.72 (95% confidence interval 0.64-0.80) was similar to the visual DWI-FLAIR mismatch (area under the curve = 0.65; 95% confidence interval 0.58-0.72; p for difference = 0.18). An automated analysis of DWI performs at least as good as the visual DWI-FLAIR mismatch in selecting patients within the 4.5-hour time window.
DOI: 10.1212/WNL.0000000000005413
ORCID: 0000-0002-6614-8417
PubMed URL: 29618622
Type: Journal Article
Appears in Collections:Journal articles

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