Refining the Definition of the Malignant Profile Insights From the DEFUSE-EPITHET Pooled Data Set

Title
Refining the Definition of the Malignant Profile Insights From the DEFUSE-EPITHET Pooled Data Set
Author(s)
이준Michael mlynash[Michael mlynash]Maarten G. Lansberg[Maarten G. Lansberg]Deidre A. De Silva[Deidre A. De Silva]Soren Christensen[Soren Christensen]Matus Straka[Matus Straka]Bruce C.V. Campbell[Bruce C.V. Campbell]Roland Bammer[Roland Bammer]Jean-Marc Olivot[Jean-Marc Olivot]Patricia Desmond[Patricia Desmond]Geoffrey A. Donnan[Geoffrey A. Donnan]Stephen M. Davis[Stephen M. Davis]Gregory W. Albers[Gregory W. Albers]
Keywords
WEIGHTED IMAGING LESION; ACUTE STROKE; DIFFUSION; REPERFUSION; ECASS
Issue Date
201105
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
STROKE, v.42, no.5, pp.1270 - 1275
Abstract
Background and Purpose-To refine the definition of the malignant magnetic resonance imaging profile in acute stroke patients using baseline diffusion-weighted magnetic resonance imaging (DWI) and perfusion-weighted magnetic resonance imaging (PWI) findings from the pooled DEFUSE/EPITHET database. Methods-Patients presenting with acute stroke within 3 to 6 hours from symptom onset were treated with tissue plasminogen activator or placebo. Baseline and follow-up DWI and PWI images from both studies were reprocessed using the same software program. A receiver operating characteristic curve analysis was used to identify Tmax and DWI volumes that optimally predicted poor outcomes (modified Rankin Scale 5-6) at 90 days in patients who achieved reperfusion. Results-Sixty-five patients achieved reperfusion and 46 did not reperfuse. Receiver operating characteristic analysis identified a PWI (Tmax>8 s) volume of >85 mL as the optimal definition of the malignant profile. Eighty-nine percent of malignant profile patients had poor outcome with reperfusion versus 39% of patients without reperfusion (P=0.02). Parenchymal hematomas occurred more frequently in malignant profile patients who experienced reperfusion versus no reperfusion (67% versus 11%, P<0.01). DWI analysis identified a volume of 80 mL as the best DWI threshold, but this definition was less sensitive than were PWI-based definitions. Conclusions-Stroke patients likely to suffer parenchymal hemorrhages and poor outcomes following reperfusion can be identified from baseline magnetic resonance imaging findings. The current analysis demonstrates that a PWI threshold (Tmax>8 s) of approximately 100 mL is appropriate for identifying these patients. Exclusion of malignant profile patients from reperfusion therapies may substantially improve the efficacy and safety of reperfusion therapies.
URI
http://hdl.handle.net/YU.REPOSITORY/25189http://dx.doi.org/10.1161/STROKEAHA.110.601609
ISSN
0039-2499
Appears in Collections:
의과대학 > 신경과학교실 > Articles
Files in This Item:
There are no files associated with this item.
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE