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dc.contributor.authorBivard, A
dc.contributor.authorKleinig, T
dc.contributor.authorChurilov, L
dc.contributor.authorLevi, C
dc.contributor.authorLin, L
dc.contributor.authorCheng, X
dc.contributor.authorChen, C
dc.contributor.authorAviv, R
dc.contributor.authorChoi, PMC
dc.contributor.authorSpratt, NJ
dc.contributor.authorButcher, K
dc.contributor.authorDong, Q
dc.contributor.authorParsons, M
dc.date.accessioned2020-11-17T03:20:43Z
dc.date.available2020-11-17T03:20:43Z
dc.date.issued2020-09
dc.identifier.citationBivard, A., Kleinig, T., Churilov, L., Levi, C., Lin, L., Cheng, X., Chen, C., Aviv, R., Choi, P. M. C., Spratt, N. J., Butcher, K., Dong, Q. & Parsons, M. (2020). Permeability Measures Predict Hemorrhagic Transformation after Ischemic Stroke. ANNALS OF NEUROLOGY, 88 (3), pp.466-476. https://doi.org/10.1002/ana.25785.
dc.identifier.issn0364-5134
dc.identifier.urihttp://hdl.handle.net/11343/251477
dc.description.abstractObjective We sought to examine the diagnostic utility of existing predictors of any hemorrhagic transformation (HT) and compare them with new perfusion imaging permeability measures in ischemic stroke patients receiving alteplase only. Methods A pixel‐based analysis of pretreatment CT perfusion (CTP) was undertaken to define the optimal CTP permeability thresholds to predict the likelihood of HT. We then compared previously proposed predictors of HT using regression analyses and receiver operating characteristic curve analysis to produce an area under the curve (AUC). We compared AUCs using χ2 analysis. Results From 5 centers, 1,407 patients were included in this study; of these, 282 had HT. The cohort was split into a derivation cohort (1,025, 70% patients) and a validation cohort (382 patients or 30%). The extraction fraction (E) permeability map at a threshold of 30% relative to contralateral had the highest AUC at predicting any HT (derivation AUC 0.85, 95% confidence interval [CI], 0.79–0.91; validation AUC 0.84, 95% CI 0.77–0.91). The AUC improved when permeability was assessed within the acute perfusion lesion for the E maps at a threshold of 30% (derivation AUC 0.91, 95% CI 0.86–0.95; validation AUC 0.89, 95% CI 0.86–0.95). Previously proposed associations with HT and parenchymal hematoma showed lower AUC values than the permeability measure. Interpretation In this large multicenter study, we have validated a highly accurate measure of HT prediction. This measure might be useful in clinical practice to predict hemorrhagic transformation in ischemic stroke patients before receiving alteplase alone.
dc.languageEnglish
dc.publisherWILEY
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.titlePermeability Measures Predict Hemorrhagic Transformation after Ischemic Stroke
dc.typeJournal Article
dc.identifier.doi10.1002/ana.25785
melbourne.affiliation.departmentMedicine and Radiology
melbourne.source.titleAnnals of Neurology
melbourne.source.volume88
melbourne.source.issue3
melbourne.source.pages466-476
dc.rights.licenseCC BY-NC-ND
melbourne.elementsid1449619
melbourne.contributor.authorBivard, Andrew
melbourne.contributor.authorChurilov, Leonid
melbourne.contributor.authorParsons, Mark
dc.identifier.eissn1531-8249
melbourne.accessrightsOpen Access


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