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Individualized quantification of the benefit from reperfusion therapy using stroke predictive models

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DOI

  • Brice Ozenne, Rigshospitalet, Københavns Universitet
  • ,
  • Tae Hee Cho, Université Lyon 1, Hospices Civils de Lyon
  • ,
  • Irene Klærke Mikkelsen
  • Marc Hermier, Hospices Civils de Lyon, Université Lyon 1
  • ,
  • Götz Thomalla, University Medical Center Hamburg-Eppendorf
  • ,
  • Salvador Pedraza, University of Girona
  • ,
  • Pascal Roy, Hospices Civils de Lyon, Université Lyon 1
  • ,
  • Yves Berthezène, Université Lyon 1
  • ,
  • Norbert Nighoghossian, Université Lyon 1
  • ,
  • Leif Østergaard
  • Jean Claude Baron, University of Cambridge
  • ,
  • Delphine Maucort-Boulch, Hospices Civils de Lyon, Université Lyon 1

Purpose: Recent imaging developments have shown the potential of voxel-based models in assessing infarct growth after stroke. Many models have been proposed but their relevance in predicting the benefit of a reperfusion therapy remains unclear. We searched for a predictive model whose volumetric predictions would identify stroke patients who are to benefit from tissue plasminogen activator (t-PA)-induced reperfusion. Material and Methods: Forty-five cases were used to study retrospectively stroke progression from admission to end of follow-up. Predictive approaches based on various statistical models, predictive variables and spatial filtering methods were compared. The optimal approach was chosen according to the area under the precision-recall curve (AUPRC). The final lesion volume was then predicted assuming that the patient would or would not reperfuse. Patients, with an acute lesion of ≤50 ml and a predicted reduction in the presence of reperfusion >6 ml and >25% of the acute lesion, were classified as responders. Results: The optimal model was a logistic regression using the voxel distance to the acute lesion, the volume of the acute lesion and Gaussian-filtered MRI contrast parameters as predictive variables. The predictions gave a median AUPRC of 0.655, a median AUC of 0.976 and a median volumetric error of 8.29 ml. Nineteen patients matched the responder profile. A non-significant trend of improved reduction in NIHSS score (−42.8%, p =.09) and in lesion volume (−78.1%, p = 0.21) following reperfusion was observed for responder patients. Conclusion: Despite limited volumetric accuracy, predictive stroke models can be used to quantify the benefit of reperfusion therapies.

Original languageEnglish
JournalEuropean Journal of Neuroscience
Volume50
Issue8
Pages (from-to)3251-3260
Number of pages10
ISSN0953-816X
DOIs
Publication statusPublished - Oct 2019

    Research areas

  • magnetic resonance imaging, predictive modelling, reperfusion, stroke

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