Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging

Dennys Reyes, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Alexis N. Simpkins, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Emi Hitomi, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
John K. Lynch, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Amie W. Hsia, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Zurab Nadareishvili, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Marie Luby, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Lawrence L. Latour, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).
Richard Leigh, Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (D.R., A.N.S., E.H., J.K.L., A.W.H., Z.N., M.L., L.L.L., R.L.).

Document Type

Journal Article

Publication Date

7-22-2022

Journal

Stroke

DOI

10.1161/STROKEAHA.121.038101

Keywords

ROC curve; humans; ischemic stroke; linear models; perfusion

Abstract

BACKGROUND: Perfusion weighted imaging (PWI) is critical for determining whether stroke patients presenting in an extended time window are candidates for mechanical thrombectomy. However, PWI is not always available. Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are seen in patients with a PWI lesion. We investigated whether a scale measuring the extent FHV could serve as a surrogate for PWI to determine eligibility for thrombectomy. METHODS: The National Institutes of Health (NIH) FHV score was developed to quantify the burden of FHV and applied to magnetic resonance imaging scans of stroke patients with fluid-attenuated inversion recovery and perfusion imaging. The NIH-FHV was combined with the diffusion weighted image volume to estimate the diffusion-perfusion mismatch ratio. Linear regression was used to compare PWI volumes and mismatch ratios with estimates from the NIH-FHV score. Receiver operating characteristic analysis was used to test the ability of the NIH-FHV score to identify a significant mismatch. RESULTS: There were 101 patients included in the analysis, of whom 78% had a perfusion deficit detected on PWI with a mean lesion volume of 47 (±59) mL. The NIH-FHV score was strongly associated with the PWI lesion volume (<0.001; R=0.32; β-coefficient, 0.57). When combined with diffusion weighted image lesion volume, receiver operating characteristic analysis testing the ability to detect a mismatch ratio ≥1.8 using the NIH-FHV score resulted in an area under the curve of 0.94. CONCLUSIONS: The NIH-FHV score provides an estimate of the PWI lesion volume and, when combined with diffusion weighted imaging, may be helpful when trying to determine whether there is a clinically relevant diffusion-perfusion mismatch in situations where perfusion imaging is not available. Further studies are needed to validate this approach.

Department

Neurology

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