Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke
Background Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large‐vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff val...
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012558 |
| _version_ | 1811332024672190464 |
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| author | Takeshi Yoshimoto Manabu Inoue Hiroshi Yamagami Kyohei Fujita Kanta Tanaka Daisuke Ando Kazutaka Sonoda Naruhiko Kamogawa Masatoshi Koga Masafumi Ihara Kazunori Toyoda |
| author_facet | Takeshi Yoshimoto Manabu Inoue Hiroshi Yamagami Kyohei Fujita Kanta Tanaka Daisuke Ando Kazutaka Sonoda Naruhiko Kamogawa Masatoshi Koga Masafumi Ihara Kazunori Toyoda |
| author_sort | Takeshi Yoshimoto |
| collection | DOAJ |
| description | Background Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large‐vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large‐vessel occlusion regardless of reperfusion therapy. Methods and Results Consecutive acute ischemic stroke patients with anterior large‐vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and diffusion‐weighted imaging lesion ischemic core volume (VolDWI) were measured in acute ischemic stroke patients with large‐vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3 months, and optimal DWI‐ASPECTS and VolDWI for unfavorable outcome were assessed. In total, 198 patients (111 men, 77±13 years old) were enrolled. Median DWI‐ASPECTS was 7 (5‐9), and median VolDWI was 55 (6‐134) mL. Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for DWI‐ASPECTS and VolDWI were 4 (area under the curve 0.78, P<0.01; sensitivity 0.71, specificity 0.75) and 71 mL (area under the curve 0.80, P<0.01; sensitivity 0.76, specificity 0.77), respectively. Conclusions The cutoff values for our redefined malignant profile were DWI‐ASPECTS 4 and VolDWI 71 mL with no selection bias for reperfusion therapy in the real‐world clinical practice. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02251665 |
| first_indexed | 2024-04-13T16:29:38Z |
| format | Article |
| id | doaj.art-65802ef3f8884349b814fe85f054bc87 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:29:38Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-65802ef3f8884349b814fe85f054bc872022-12-22T02:39:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182210.1161/JAHA.119.012558Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute StrokeTakeshi Yoshimoto0Manabu Inoue1Hiroshi Yamagami2Kyohei Fujita3Kanta Tanaka4Daisuke Ando5Kazutaka Sonoda6Naruhiko Kamogawa7Masatoshi Koga8Masafumi Ihara9Kazunori Toyoda10Department of Neurology National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanBackground Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large‐vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large‐vessel occlusion regardless of reperfusion therapy. Methods and Results Consecutive acute ischemic stroke patients with anterior large‐vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and diffusion‐weighted imaging lesion ischemic core volume (VolDWI) were measured in acute ischemic stroke patients with large‐vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3 months, and optimal DWI‐ASPECTS and VolDWI for unfavorable outcome were assessed. In total, 198 patients (111 men, 77±13 years old) were enrolled. Median DWI‐ASPECTS was 7 (5‐9), and median VolDWI was 55 (6‐134) mL. Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for DWI‐ASPECTS and VolDWI were 4 (area under the curve 0.78, P<0.01; sensitivity 0.71, specificity 0.75) and 71 mL (area under the curve 0.80, P<0.01; sensitivity 0.76, specificity 0.77), respectively. Conclusions The cutoff values for our redefined malignant profile were DWI‐ASPECTS 4 and VolDWI 71 mL with no selection bias for reperfusion therapy in the real‐world clinical practice. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02251665https://www.ahajournals.org/doi/10.1161/JAHA.119.012558large‐vessel occlusionmalignant profilestroke |
| spellingShingle | Takeshi Yoshimoto Manabu Inoue Hiroshi Yamagami Kyohei Fujita Kanta Tanaka Daisuke Ando Kazutaka Sonoda Naruhiko Kamogawa Masatoshi Koga Masafumi Ihara Kazunori Toyoda Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease large‐vessel occlusion malignant profile stroke |
| title | Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke |
| title_full | Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke |
| title_fullStr | Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke |
| title_full_unstemmed | Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke |
| title_short | Use of Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke |
| title_sort | use of diffusion weighted imaging alberta stroke program early computed tomography score dwi aspects and ischemic core volume to determine the malignant profile in acute stroke |
| topic | large‐vessel occlusion malignant profile stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012558 |
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