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European Radiology

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Open Access 01-02-2022 | Stroke | Neuro

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

Authors: Silvia Pistocchi, Davide Strambo, Bruno Bartolini, Philippe Maeder, Reto Meuli, Patrik Michel, Vincent Dunet

Published in: European Radiology | Issue 2/2022

Abstract

Objective

Impact of different MR perfusion software on selection and outcome of patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO) treated by endovascular thrombectomy (EVT) is unclear. We aimed at comparing two commercial MRI software, semi-automated with unadjusted (method A) and adjusted mask (method B), and fully automated (method C) in this setting.

Methods

MRI from 144 consecutive AIS patients with anterior circulation LVO was retrospectively analysed. All diffusion- and perfusion-weighted images (DWI-PWI) were post-processed with the three methods using standard thresholds. Concordance for core and hypoperfusion volumes was assessed with Lin’s test. Clinical outcome was compared between groups in patients who underwent successful EVT in the early and late time window.

Results

Mean core volume was higher and mean hypoperfusion volume was lower in method C than in methods A and B. In the early time window, methods A and B found fewer patients with a mismatch ratio ≤ 1.2 than method C (1/67 [1.5%] vs. 12/67 [17.9%], p = 0.0013). In the late time window, methods A and B found fewer patients with a mismatch ratio < 1.8 than method C (3/46 [6.5%] and 2/46 [4.3%] vs. 18/46 [39.1%], p ≤ 0.0002). More patients with functional independence at 3 months would not have been treated using method C versus methods A and B in the early (p = 0.0063) and late (p ≤ 0.011) time window.

Conclusions

MRI software for DWI-PWI analysis may influence patients’ selection before EVT and clinical outcome.

Key Points

• Method C detects fewer patients with favourable mismatch profile.

• Method C might underselect more patients with functional independence at 3 months.

• Software used before thrombectomy may influence patients’ outcome.

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Title: MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome
Authors: Silvia Pistocchi
Davide Strambo
Bruno Bartolini
Philippe Maeder
Reto Meuli
Patrik Michel
Vincent Dunet
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Thrombectomy
Published in: European Radiology / Issue 2/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08211-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

Abstract

Objective

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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