Introduction
Materials and methods
Patient cohort
Imaging acquisition and post-processing
Method A
Method B
Method C
Statistical analysis
Results
Study population and technical success of perfusion imaging
Enrolled patients | N = 144 |
---|---|
Males | 71 (49.3%) |
Age (y) | 74.6 ± 11.8 |
Cardiovascular risk factors | |
Hypertension | 112 (77.7%) |
Diabetes | 37 (25.7%) |
Hypercholesterolemia | 114 (79.2%) |
Smoking | 38 (26.4%) |
Atrial fibrillation | 58 (40.3%) |
Coronaropathy | 36 (25%) |
Active cancer | 16 (11.1%) |
Stroke aetiology (TOAST) | |
Large artery atherosclerosis | 22 (15.3%) |
Cardiac embolism | 65 (45.1%) |
Small vessel disease | 0 (0%) |
Cervical artery dissection | 3 (2%) |
Patent foramen ovale | 0 (0%) |
Other determined aetiologies | 10 (6.9%) |
More than one possible aetiology | 10 (6.9%) |
Unknown aetiology despite complete evaluation | 22 (15.3%) |
Unknown aetiology with incomplete evaluation | 6 (4.2%) |
NIHSS at admission | 12.4 ± 7.2 |
Treatment | |
IVT | 74 (51.4%) |
EVT | 115 (79.9%) |
Conservative | 15 (10.4%) |
Outcome | |
NIHSS at 7 days | 9.7 ± 13.3 |
mRS at 7 days | 3.1 ± 1.6 |
mRS 3 months | 3.2 ± 2.0 |
sICHECASS | 5 (3.5%) |
Inter-method concordance analysis
Parameters | Method A | Method B | Method C |
---|---|---|---|
All patients (N = 142) | |||
Core (mL) | 22.7 ± 38.7 | 19.1 ± 35.3 | 36.8 ± 52.2 |
Hypoperfusion (mL) | 160.3 ± 118.9 | 117.9 ± 78.4 | 84.5 ± 74.0 |
Early EVT (N = 67) | |||
Core (mL) | 19.2 ± 34.7 | 15.8 ± 31.5 | 31.0 ± 46.1 |
Hypoperfusion (mL) | 166.8 ± 122.7 | 121.2 ± 71.1 | 82.9 ± 60.1 |
Mismatch ratio | |||
≤ 1.2 | 1 (1.5%) | 1 (1.5%) | 12 (17.9%) |
> 1.2 | 66 (98.5%) | 66 (98.5%) | 55 (82.1%) |
Late EVT (N = 46) | |||
Core (mL) | 20.4 ± 25.7 | 17.4 ± 24.4 | 35.6 ± 44.5 |
Hypoperfusion (mL) | 144.1 ± 106.4 | 111.1 ± 78.6 | 83.3 ± 77.8 |
Mismatch ratio | |||
< 1.8 | 3 (6.5%) | 2 (4.3%) | 18 (39.1%) |
≥ 1.8 | 43 (93.5%) | 44 (95.7%) | 28 (60.9%) |
Pairs | Pearson’ rho | Rho_c | C_b | Mean difference | 95% LOA |
---|---|---|---|---|---|
All patients (N = 142) | |||||
Core volume | |||||
Method A versus B | 0.97 | 0.96 | 0.99 | 3.6 ± 10.0 | −16.0 to 23.1 |
Method A versus C | 0.90 | 0.82 | 0.91 | −14.1 ± 24.5 | −62.2 to 34.0 |
Method B versus C | 0.94 | 0.80 | 0.86 | −18.1 ± 23.7 | −64.5 to 28.2 |
Hypoperfusion volume | |||||
Method A versus B | 0.74 | 0.62 | 0.85 | 41.8 ± 80.5 | −115.9 to 199.6 |
Method A versus C | 0.38 | 0.27 | 0.69 | 75.8 ± 113.4 | −146.5 to 298.2 |
Method B versus C | 0.56 | 0.51 | 0.91 | 33.4 ± 71.7 | −107.1 to 174.0 |
Early EVT (N = 67) | |||||
Core volume | |||||
Method A versus B | 0.97 | 0.96 | 0.99 | 3.4 ± 8.9 | −14.2 to 20.9 |
Method A versus C | 0.88 | 0.81 | 0.92 | −11.8 ± 22.9 | −56.8 to 33.1 |
Method B versus C | 0.92 | 0.79 | 0.87 | −15.2 ± 21.5 | −57.2 to 26.8 |
Hypoperfusion volume | |||||
Method A versus B | 0.69 | 0.54 | 0.79 | 45.6 ± 89.7 | −130.2 to 221.4 |
Method A versus C | 0.37 | 0.21 | 0.57 | 83.8 ± 115.0 | −141.5 to 309.2 |
Method B versus C | 0.59 | 0.50 | 0.84 | 38.2 ± 60.0 | −79.4 to 155.9 |
Late EVT (N = 46) | |||||
Core volume | |||||
Method A versus B | 0.97 | 0.96 | 0.99 | 3.0 ± 6.5 | −9.8 to 15.8 |
Method A versus C | 0.93 | 0.74 | 0.80 | −15.2 ± 22.5 | −59.3 to 28.8 |
Method B versus C | 0.94 | 0.70 | 0.75 | −18.2 ± 23.2 | −63.7 to 27.2 |
Hypoperfusion volume | |||||
Method A versus B | 0.88 | 0.79 | 0.90 | 33.0 ± 52.4 | −69.6 to 135.7 |
Method A versus C | 0.51 | 0.40 | 0.78 | 60.8 ± 94.6 | −124.6 to 246.2 |
Method B versus C | 0.63 | 0.60 | 0.94 | 27.8 ± 67.0 | −103.5 to 159.0 |
Estimation of unfavourable mismatch profile and outcome in patients who underwent EVT
Early time window
Method A | TICI2b/2c/3, n = 63 | MR ≤ 1.2, n = 1 | MR > 1.2, n = 62 | p value |
---|---|---|---|---|
NIHSS admission NIHSS 7d | 12.3 ± 7.3 7.4 ± 12.2‡ | 27 28 | 12.1 ± 7.1 7.0 ± 12.0‡ | NA NA |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.0 ± 1.1 2.8 ± 1.6 2.7 ± 1.9 31/63 (49.2%) 31/63 (49.2%) | 0 5 3 0/63 (0%) 0/63 (0%) | 1.1 ± 1.1 2.7 ± 1.6 2.7 ± 1.9 31/63 (49.2%) 31/63 (49.2%) | NA NA NA < 0.0001 < 0.0001 |
sICHECASS | 3/63 (4.8%) | 0/63 (0%) | 3/63 (4.8%) | 0.07 |
Method B | TICI2b/2c/3, n = 63 | MR ≤ 1.2, n = 1 | MR > 1.2, n = 62 | p value |
NIHSS admission NIHSS 7d | 12.3 ± 7.3 7.4 ± 12.2‡ | 20 42 | 12.2 ± 7.3 6.8 ± 11.4‡ | NA NA |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.0 ± 1.1 2.8 ± 1.6 2.7 ± 1.9 31/63 (49.2%) 31/63 (49.2%) | 0 6 6 0/63 (0%) 0/63 (0%) | 1.1 ± 1.1 2.7 ± 1.5 2.6 ± 1.9 31/63 (49.2%) 31/63 (49.2%) | NA NA NA < 0.0001 < 0.0001 |
sICHECASS | 3/63 (4.8%) | 0/63 (0%) | 3/63 (4.8%) | 0.07 |
Method C | TICI2b/2c/3, n = 63 | MR ≤ 1.2, n = 12 | MR > 1.2, n = 51 | p value |
NIHSS admission NIHSS 7d | 12.3 ± 7.3 7.4 ± 12.2‡ | 13.2 ± 8.0 6.6 ± 7.7 | 12.1 ± 7.1 7.6 ± 13.2† | 0.62 0.48 |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.0 ± 1.1 2.8 ± 1.6 2.7 ± 1.9 31/63 (49.2%) 31/63 (49.2%) | 1.0 ± 0.9 2.8 ± 1.6 2.6 ± 2.1 6/63 (9.5%) 6/63 (9.5%) | 1.1 ± 1.2 2.8 ± 1.6 2.7 ± 1.9 25/63 (39.7%) 25/63 (39.7%) | 0.98 0.21 0.23 < 0.0001 < 0.0001 |
sICHECASS | 3/63 (4.8%) | 0/63 (0%) | 3/63 (4.8%) | 0.07 |
Late time window
Method A | TICI2b/3, n = 42 | MR < 1.8, n = 3 | MR ≥ 1.8, n = 39 | p value |
---|---|---|---|---|
NIHSS admission NIHSS 7d | 13.8 ± 6.3 8.6 ± 11.0† | 9.3 ± 3.1 3.0 ± 2.6† | 14.2 ± 6.4 9.1 ± 11.4† | 0.14 0.58 |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.1 ± 1.1 3.0 ± 1.4 3.0 ± 1.9 15/42 (35.7%) 18/42 (42.9%) | 1.3 ± 0.6 2.3 ± 0.6 1.7 ± 0.6 2/42 (4.8%) 3/42 (7.1%) | 1.1 ± 1.1 3.1 ± 1.5 3.1 ± 1.9 13/42 (31.0%) 15/42 (35.7%) | 0.54 0.36 0.21 0.0002 0.0001 |
sICHECASS | 2/42 (4.8%) | 0/42 (0%) | 2/42 (4.8%) | 0.27 |
Method B | TICI2b/3, n = 42 | MR < 1.8, n = 2 | MR ≥ 1.8, n = 40 | p value |
NIHSS admission NIHSS 7d | 13.8 ± 6.3 8.6 ± 11.0† | 11.0 ± 1.4 18.5 ± 24.7 | 14.0 ± 6.4 8.1 ± 10.2‡ | 0.46 0.57 |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.1 ± 1.1 3.0 ± 1.4 3.0 ± 1.9 15/42 (35.7%) 18/42 (42.9%) | 1.0 ± 0.0 3.5 ± 2.1 3.5 ± 3.5 1/42 (2.4%) 1/42(2.4%) | 1.2 ± 1.1 3.0 ± 1.4 2.9 ± 1.8 14/42 (33.3%) 17/42 (40.5%) | 1.0 0.63 0.94 < 0.0001 < 0.0001 |
sICHECASS | 2/42 (4.8%) | 0/42 (0%) | 2/42 (4.8%) | 0.27 |
Method C | TICI2b/3, n = 42 | MR < 1.8, n = 16 | MR ≥ 1.8, n = 26 | p value |
NIHSS admission NIHSS 7d | 13.8 ± 6.3 8.6 ± 11.0† | 14.9 ± 6.1 9.3 ± 9.8† | 13.2 ± 6.4 8.1 ± 12.1† | 0.53 0.28 |
mRS pre-stroke mRS 7d mRS 3 months mRS 0–2 at 7d mRS 0–2 at 3m | 1.1 ± 1.1 3.0 ± 1.4 3.0 ± 1.9 15/42 (35.7%) 18/42 (42.9%) | 1.3 ± 0.8 3.2 ± 1.1 2.9 ± 1.7 4/42 (9.5%) 7/42 (16.7%) | 1.0 ± 1.2 2.9 ± 1.6 3.0 ± 2.1 11/42 (26.2%) 11/42 (26.2%) | 0.18 0.46 0.88 0.014 0.16 |
sICHECASS | 2/42 (4.8%) | 1/42 (2.4%) | 1/42 (2.4%) | 1.0 |