Location-weighted versus Volume-weighted Mismatch at MRI for Response to Mechanical Thrombectomy in Acute Stroke.
Radiology. 2023-02-01; 306(2):
DOI: 10.1148/radiol.220080
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Fukutomi H(1), Yamamoto T(1), Sibon I(1), Christensen S(1), Raposo N(1), Marnat G(1), Albucher JF(1), Olindo S(1), Calvière L(1), Sagnier S(1), Viguier A(1), Renou P(1), Guenego A(1), Poli M(1), Darcourt J(1), Debruxelles S(1), Drif A(1), Thalamas C(1), Sommet A(1), Rousseau V(1), Mazighi M(1), Bonneville F(1), Albers GW(1), Cognard C(1), Dousset V(1), Olivot JM(1), Tourdias T(1); BBS and FRAME investigators(1).
Collaborators: Fontaine L, Chollet F, Barbieux M, Michelozzi C, Tall P, Januel
AC, Caparros F, Pouzet B, Calvas F, Galitzki M, Rouanet F, Ledure S, Ménégon P,
Berge J, Barreau X, Gariel F, Asselineau J, Perez P, Mlynash M.
Author information:
(1)From the Institut de Bio-Imagerie IBIO (H.F., T.Y., V.D., T.T.), CNRS,
UMR-5287 (I.S., S.S.), and INSERM, Neurocentre Magendie, U1215 (V.D., T.T.),
Université Bordeaux, 146 rue Léo Saignat, F-33000 Bordeaux Cedex, France; Unité
Neurovasculaire (I.S., S.O., S.S., P.R., M.P., S.D.) and Neuroimagerie
Diagnostique et Thérapeutique (G.M., V.D., T.T.), CHU de Bordeaux, Bordeaux,
France; Stanford Stroke Center, Stanford University, Stanford, Calif (S.C.,
G.W.A.); Unité Neurovasculaire (N.R., J.F.A., L.C., A.V., J.M.O.), Service de
Neuroradiologie (A.G., J.D., F.B., C.C.), and Centre d’Investigation Clinique
(A.D., C.T., A.S., V.R.), CHU de Toulouse, Toulouse, France; and Fondation
Ophtalmologique Adolphe de Rothschild, Paris, France (M.M.).
Comment in
Radiology. 2022 Oct 4;:222257.
Background A target mismatch profile can identify good clinical response to
recanalization after acute ischemic stroke, but does not consider region
specificities. Purpose To test whether location-weighted infarction core and
mismatch, determined from diffusion and perfusion MRI performed in patients with
acute stroke, could improve prediction of good clinical response to mechanical
thrombectomy compared with a target mismatch profile. Materials and Methods In
this secondary analysis, two prospectively collected independent stroke data
sets (2012-2015 and 2017-2019) were analyzed. From the brain before stroke (BBS)
study data (data set 1), an eloquent map was computed through voxel-wise
associations between the infarction core (based on diffusion MRI on days 1-3
following stroke) and National Institutes of Health Stroke Scale (NIHSS) score.
The French acute multimodal imaging to select patients for mechanical
thrombectomy (FRAME) data (data set 2) consisted of large vessel
occlusion-related acute ischemic stroke successfully recanalized. From acute MRI
studies (performed on arrival, prior to thrombectomy) in data set 2, target
mismatch and eloquent (vs noneloquent) infarction core and mismatch were
computed from the intersection of diffusion- and perfusion-detected lesions with
the coregistered eloquent map. Associations of these imaging metrics with early
neurologic improvement were tested in multivariable regression models, and areas
under the receiver operating characteristic curve (AUCs) were compared. Results
Data sets 1 and 2 included 321 (median age, 69 years [IQR, 58-80 years]; 207
men) and 173 (median age, 74 years [IQR, 65-82 years]; 90 women) patients,
respectively. Eloquent mismatch was positively and independently associated with
good clinical response (odds ratio [OR], 1.14; 95% CI: 1.02, 1.27; P = .02) and
eloquent infarction core was negatively associated with good response (OR, 0.85;
95% CI: 0.77, 0.95; P = .004), while noneloquent mismatch was not associated
with good response (OR, 1.03; 95% CI: 0.98, 1.07; P = .20). Moreover, adding
eloquent metrics improved the prediction accuracy (AUC, 0.73; 95% CI: 0.65,
0.81) compared with clinical variables alone (AUC, 0.65; 95% CI: 0.56, 0.73; P =
.01) or a target mismatch profile (AUC, 0.67; 95% CI: 0.59, 0.76; P = .03).
Conclusion Location-weighted infarction core and mismatch on diffusion and
perfusion MRI scans improved the identification of patients with acute stroke
who would benefit from mechanical thrombectomy compared with the volume-based
target mismatch profile. Clinical trial registration no. NCT03045146 © RSNA,
2022 Online supplemental material is available for this article. See also the
editorial by Nael in this issue.
DOI: 10.1148/radiol.220080
PMCID: PMC9885343
PMID: 36194114 [Indexed for MEDLINE]
Conflict of interest statement: Disclosures of conflicts of interest: H.F. No
relevant relationships. T.Y. No relevant relationships. I.S. Consulting fees
and/or lecture payments, Sanofi Synthélabo, Servier, Boheringer Ingelheim,
AstraZeneca, Novo Nordisk, Medtronic, and Bristol Myers Squibb–Pfizer. S.C.
Stockholder, iSchemaview. N.R. No relevant relationships. G.M. Consulting fees,
Stryker Neurovascular and Balt Extrusion; lecture payments, Microvention Europe.
J.F.A. No relevant relationships. S.O. No relevant relationships. L.C.
Consulting fees, Alexion, AstraZeneca, and Re-Imagine Health Agency; honoraria,
Pfizer and Bristol Myers Squibb. S.S. No relevant relationships. A.V. No
relevant relationships. P.R. No relevant relationships. A.G. No relevant
relationships. M.P. No relevant relationships. J.D. No relevant relationships.
S.D. No relevant relationships. A.D. No relevant relationships. C.T. No relevant
relationships. A.S. No relevant relationships. V.R. No relevant relationships.
M.M. No relevant relationships. F.B. No relevant relationships. G.W.A. Grants,
National Institutes of Health; consulting fees, Genentech and iSchemaView;
advisory board, Genentech; leadership and stockholder, iSchemaview. C.C.
Consulting fees, Stryker, Medtronic, Cerenovus, Mivi, and Microvention. V.D. No
relevant relationships. J.M.O. Grants, French Department of Health; consulting
fees, AbbVie and Acticor; honoraria, Bristol Myers Squibb; advisory board,
Direct Angio and Nets Target. T.T. No relevant relationships.