AUTHOR=Sporns Peter B. , Kemmling André , Meyer Lennart , Krogias Christos , Puetz Volker , Thierfelder Kolja M. , Duering Marco , Lukas Carsten , Kaiser Daniel , Langner Sönke , Brehm Alex , Rotkopf Lukas T. , Kunz Wolfgang G. , Beuker Carolin , Heindel Walter , Fiehler Jens , Schramm Peter , Wiendl Heinz , Minnerup Heike , Psychogios Marios Nikos , Minnerup Jens 

TITLE=Computed tomography hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch to identify stroke patients eligible for thrombolysis

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1320620

DOI=10.3389/fneur.2023.1320620

ISSN=1664-2295

ABSTRACT=<sec id="sec1"><title>Background and purpose</title><p>Automated perfusion imaging can detect stroke patients with unknown time of symptom onset who are eligible for thrombolysis. However, the availability of this technique is limited. We, therefore, established the novel concept of computed tomography (CT) hypoperfusion-hypodensity mismatch, i.e., an ischemic core lesion visible on cerebral perfusion CT without visible hypodensity in the corresponding native cerebral CT. We compared both methods regarding their accuracy in identifying patients suitable for thrombolysis.</p></sec><sec id="sec2"><title>Methods</title><p>In a retrospective analysis of the MissPerfeCT observational cohort study, patients were classified as suitable or not for thrombolysis based on established time window and imaging criteria. We calculated predictive values for hypoperfusion-hypodensity mismatch and automated perfusion imaging to compare accuracy in the identification of patients suitable for thrombolysis.</p></sec><sec id="sec3"><title>Results</title><p>Of 247 patients, 219 (88.7%) were eligible for thrombolysis and 28 (11.3%) were not eligible for thrombolysis. Of 197 patients who were within 4.5 h of symptom onset, 190 (96.4%) were identified by hypoperfusion-hypodensity mismatch and 88 (44.7%) by automated perfusion mismatch (<italic>p</italic> &lt; 0.001). Of 22 patients who were beyond 4.5 h of symptom onset but were eligible for thrombolysis, 5 patients (22.7%) were identified by hypoperfusion-hypodensity mismatch. Predictive values for the hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch were as follows: sensitivity, 89.0% vs. 50.2%; specificity, 71.4% vs. 100.0%; positive predictive value, 96.1% vs. 100.0%; and negative predictive value, 45.5% vs. 20.4%.</p></sec><sec id="sec4"><title>Conclusion</title><p>The novel method of hypoperfusion-hypodensity mismatch can identify patients suitable for thrombolysis with higher sensitivity and lower specificity than established techniques. Using this simple method might therefore increase the proportion of patients treated with thrombolysis without the use of special automated software.</p><p>The MissPerfeCT study is a retrospective observational multicenter cohort study and is registered with <uri xlink:href="http://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">clinicaltrials.gov</uri> (NCT04277728).</p></sec>