• Brice Ozenne, Tae-Hee Cho, Irene Klaerke Mikkelsen, Marc Hermier, Lars Ribe, Götz Thomalla, Salvador Pedraza, Jean-Claude Baron, Pascal Roy, Yves Berthezène, Norbert Nighoghossian, Leif Østergaard, and Delphine Maucort-Boulch.
• Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France.
• J Neuroimaging. 2015 Nov 1; 25 (6): 952-8.

Background And PurposeThough still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.MethodsEarly reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated.ResultsMTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification.ConclusionsTTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.Copyright © 2015 by the American Society of Neuroimaging.

25 keywords...

hide…