Abstract
Background and Objectives To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset. Methods We therefore performed the Retrospective Multicenter Hypoperfusion-Hypodensity Mismatch for The identification of Patients With Stroke Within 4.5 Hours study of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure. Results Of 666 patients, 548 (82.3%) had multimodal CT within 4.5 hours and 118 (17.7%) beyond 4.5 hours. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% confidence interval [CI] 91.9%–95.8%) sensitivity, 74.6% (95% CI 66.0%–81.6%) specificity, 94.5% (95% CI 92.3%–96.1%) positive predictive value, and 73.3% (95% CI 64.8%–80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ = 0.61, 95% CI 0.53–0.69). Discussion Patients with acute ischemic stroke with absence of a hypodensity on native CT (NCCT) within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset.
| Original language | English |
|---|---|
| Journal | Neurology |
| Volume | 97 |
| Issue number | 21 |
| Pages (from-to) | E2088-E2095 |
| ISSN | 0028-3878 |
| DOIs | |
| Publication status | Published - 23.11.2021 |
Funding
P.B. Sporns, A. Kemmling, H. Minnerup, and L. Meyer report no disclosures relevant to the manuscript. C. Krogias has received honoraria and travel grants from Bayer Vital and Daiichi-Sankyo. V. Puetz, K. Thierfelder, and M. Duering report no disclosures relevant to the manuscript. D. Kaiser receives a grant from Else Kröner-Fresenius-Center for Digital Health. S. Langner, C. Massoth, A. Brehm, L. Rotkopf, W.G. Kunz, and A. Karch report no disclosures relevant to the manuscript. J. Fiehler has received grants from German Federal Ministry of Education and Research, German Ministry of Economy and Innovation, German Research Foundation, European Union, Hamburgische Investitions-und Förderbank, Medtronic, Microvention, Route92, and Stryker. He serves as a consultant for Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Microvention, Penumbra, Phenox, Stryker, and Transverse Medical and is a stockholder of Tegus Medical. W. Heindel reports no disclosures relevant to the manuscript. G. Royl has received honoraria and travel grants from Bayer Vital, Daiichi-Sankyo, Boehringer-Ingelheim, and Bristol-Myer Squibbs. P. Schramm has received grants from Siemens and Penumbra and serves as a consultant for Penumbra, Phenox, Stryker, and Cerus Endovascular. H. Wiendl and M. Psychogios report no disclosures relevant to the manuscript. J. Minnerup has received grants from the German Research Foundation, the German Federal Ministry of Education and Research, Else Kröner-Fresenius-Stiftung, EVER Pharma Jena GmbH, and Ferrer International; travel grants from Boehringer Ingelheim; and speaking fees from Bayer Vital and Chugai Pharma. Go to Neurology.org/N for full disclosures.
Research Areas and Centers
- Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)
DFG Research Classification Scheme
- 2.23-07 Clinical Neurology, Neurosurgery and Neuroradiology
