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Title: A Comparison of Relative Time to Peak and Tmax for Mismatch-Based Patient Selection.
Austin Authors: Wouters, Anke;Christensen, Søren;Straka, Matus;Mlynash, Michael;Liggins, John;Bammer, Roland;Thijs, Vincent N ;Lemmens, Robin;Albers, Gregory W;Lansberg, Maarten G
Affiliation: Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Department of Neurosciences, Experimental Neurology, Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven, Leuven, Belgium
Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium
Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA, United States
Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Issue Date: 2017 2017-10-13
Publication information: Frontiers in neurology 2017; 8: 539
Abstract: The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch profile is used to select patients for endovascular treatment. A PWI map of Tmax is commonly used to identify tissue with critical hypoperfusion. A time to peak (TTP) map reflects similar hemodynamic properties with the added benefit that it does not require arterial input function (AIF) selection and deconvolution. We aimed to determine if TTP could substitute Tmax for mismatch categorization. Imaging data of the DEFUSE 2 trial were reprocessed to generate relative TTP (rTTP) maps. We identified the rTTP threshold that yielded lesion volumes comparable to Tmax > 6 s and assessed the effect of reperfusion according to mismatch status, determined based on Tmax and rTTP volumes. Among 102 included cases, the Tmax > 6 s lesion volumes corresponded most closely with rTTP > 4.5 s lesion volumes: median absolute difference 6.9 mL (IQR: 2.3-13.0). There was 94% agreement in mismatch classification between Tmax and rTTP-based criteria. When mismatch was assessed by Tmax criteria, the odds ratio (OR) for favorable clinical response associated with reperfusion was 7.4 (95% CI 2.3-24.1) in patients with mismatch vs. 0.4 (95% CI 0.1-2.6) in patients without mismatch. When mismatch was assessed with rTTP criteria, these ORs were 7.2 (95% CI 2.3-22.2) and 0.3 (95% CI 0.1-2.2), respectively. rTTP yields lesion volumes that are comparable to Tmax and reliably identifies the PWI/DWI mismatch profile. Since rTTP is void of the problems associated with AIF selection, it is a suitable substitute for Tmax that could improve the robustness and reproducibility of mismatch classification in acute stroke.
DOI: 10.3389/fneur.2017.00539
ORCID: 0000-0002-6614-8417
PubMed URL: 29081762
ISSN: 1664-2295
Type: Journal Article
Subjects: Ischaemic Stroke
Magnetic Resonance Imaging
perfusion imaging
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