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Moving Beyond a Single Perfusion Threshold to Define Penumbra: A Novel Probabilistic Mismatch Definition.
MedLine Citation:
PMID:  22499579     Owner:  NLM     Status:  Publisher    
BACKGROUND AND PURPOSE: The mismatch lesion volumes defined by perfusion-weighted imaging (PWI) exceeding diffusion-weighted imaging (DWI) have been used as a marker of ischemic penumbral tissue. Defining the perfusion lesion by thresholding has shown promise as a practical tool; several positron emission tomography studies have indicated a more probabilistic relationship between perfusion and infarction. Here, we used a randomized controlled trial dataset of tissue-type plasminogen activator 3 to 6 hours after stroke to: (1) quantify the relationship between severity of hypoperfusion (measured by Tmax) and risk of infarction; (2) exploit this relationship to present a novel definition of mismatch based on infarct probabilities rather than dichotomies; and (3) examine the treatment response in the subgroup of patients with mismatch by the new definition. METHODS: Patients from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) were included. Baseline PWI and 90-day T2-weighted imaging were coregistered. PWI lesion volumes were divided into 10 Tmax delay strata, and infarct risk was defined as the fraction of the tissue at a given Tmax strata that progressed to infarction by day 90. RESULTS: Sixty-two patients were studied. Infarct risk was an increasing function of Tmax for all subgroups, including the whole cohort. The probabilistic approach outperformed all Tmax thresholds, with exception of the Tmax ≥10 threshold, for which it was only favored by a trend. CONCLUSIONS: Infarct risk and treatment effect increased with severity of perfusion abnormalities. This suggests that a severity-weighted mismatch definition may define penumbral tissue more accurately.
Yoshinari Nagakane; Soren Christensen; Toshiyasu Ogata; Leonid Churilov; Henry Ma; Mark W Parsons; Patricia M Desmond; Christopher R Levi; Kenneth S Butcher; Stephen M Davis; Geoffrey A Donnan;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-12
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the National Stroke Research Institute, Florey Neuroscience Institutes, Austin Health, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Mathematics and Statistics, University of Melbourne, Australia; Department of Neurology, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, Australia; Department of Neurology, University of Alberta, Edmonton, Alberta, Canada; Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia.
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