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1. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction

Author

Kauw, Frans, Bennink, Edwin, de Jong, Hugo W. A. M., Kappelle, L. Jaap, Horsch, Alexander D., Velthuis, Birgitta K., Dankbaar, Jan W., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Nijeholt, Lycklama A. G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Radiology & Nuclear Medicine, Neurology, Physics and medical technology, Radiology and nuclear medicine, VU University medical center, Dermatology, Surgery, Public and occupational health, Human genetics, Radiation Oncology, Amsterdam Neuroscience - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes

Subjects
medicine.medical_specialty, Original Contributions, infarction, Clinical Sciences, Clinical Neurology, Infarction, Perfusion scanning, All institutes and research themes of the Radboud University Medical Center, Midline shift, Internal medicine, medicine.artery, Journal Article, Medicine, odds ratio, cardiovascular diseases, Advanced and Specialised Nursing, humans, Stroke, Advanced and Specialized Nursing, brain edema, middle cerebral artery, infarction, middle cerebral artery, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Odds ratio, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Angiography, Middle cerebral artery, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Neurology (clinical), prognosis, business, Cardiology and Cardiovascular Medicine, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract

Supplemental Digital Content is available in the text., Background and Purpose— Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction. Methods— Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test. Results— Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1–11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6–21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8–23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P

Published
2019

2. Circle of Willis variations in migraine patients with ischemic stroke

Author

Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., van der Graaf, Y., Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., and van der Graaf, Y.

Published
2019

3. Circle of Willis variations in migraine patients with ischemic stroke

Author

Circulatory Health, In Vivo NMR ISI, MS Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Brain, Researchgr. Hart-brein as., JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Externen Hematologie, Affectieve & Psychotische Med., Cancer, Arts-Assistenten Onderwijs Radiologie, Arts-assistenten Radiologie, Onderzoek Beeld, ZL Algemene Neurologie Medisch, Opleiding Neurologie, Cardiovasculaire Epi Team 5, Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., van der Graaf, Y., Circulatory Health, In Vivo NMR ISI, MS Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Brain, Researchgr. Hart-brein as., JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Externen Hematologie, Affectieve & Psychotische Med., Cancer, Arts-Assistenten Onderwijs Radiologie, Arts-assistenten Radiologie, Onderzoek Beeld, ZL Algemene Neurologie Medisch, Opleiding Neurologie, Cardiovasculaire Epi Team 5, Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., and van der Graaf, Y.

Published
2019

4. Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery

Author

Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., and the DUST study group

Subjects
Medial arterial calcification, Cardiovascular disease risk factors, Atherosclerosis, Intracranial carotid artery, Cardiology and Cardiovascular Medicine
Abstract

Background and aims: Calcifications of the intracranial internal carotid artery (iICA) are an important risk factor for stroke. The calcifications can occur both in the intimal and medial layer of the vascular wall. The aim of this study is to assess whether medial calcification in the iICA is differently related to risk factors for cardiovascular disease, compared to intimal calcification. Methods: Unenhanced thin slice computed tomography (CT) scans from 1132 patients from the Dutch acute stroke study cohort were assessed for dominant localization of calcification (medial or intimal) by one of three observers based on established methodology. Associations between known cardiovascular risk factors (age, gender, body mass index, pulse pressure, eGFR, smoking, hypertension, diabetes mellitus, hyperlipidemia, previous vascular disease, and family history) and the dominant localization of calcifications were assessed via logistic regression analysis. Results: In the 1132 patients (57% males, mean age 67.4 years [SD 13.8]), dominant intimal calcification was present in 30.9% and dominant medial calcification in 46.9%. In 10.5%, no calcification was seen. Age, pulse pressure and family history were risk factors for both types of calcification. Multivariably adjusted risk factors for dominant intimal calcification only were smoking (OR 2.09 [CI 1.27–3.44]) and hypertension (OR 2.09 [CI 1.29–3.40]) and for dominant medial calcification diabetes mellitus (OR 2.39 [CI 1.11–5.14]) and previous vascular disease (OR 2.20 [CI 1.30–3.75]). Conclusions: Risk factors are differently related to the dominant localizations of calcifications, a finding that supports the hypothesis that the intimal and medial calcification represents a distinct etiology.

Published
2018

5. Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery

Author

AvL-U, Circulatory Health, Onderzoek Beeld, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Hart-brein as., Brain, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Public Health Practice, Externen Hematologie, Affectieve & Psychotische Med., Pathologie Pathologen staf, Arts-Assistenten Onderwijs Radiologie, ZL Algemene Neurologie Medisch, ZL Cerebrovasculaire Ziekten Medisch, Opleiding Neurologie, Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., the DUST study group, AvL-U, Circulatory Health, Onderzoek Beeld, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Hart-brein as., Brain, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Public Health Practice, Externen Hematologie, Affectieve & Psychotische Med., Pathologie Pathologen staf, Arts-Assistenten Onderwijs Radiologie, ZL Algemene Neurologie Medisch, ZL Cerebrovasculaire Ziekten Medisch, Opleiding Neurologie, Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., and the DUST study group

Published
2018

6. Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score

Author

Hilkens, Nina A., van Asch, Charlotte J. J., Werring, David J., Wilson, Duncan, Rinkel, Gabriël J. E., Algra, Ale, Velthuis, Birgitta K., de Kort, G. rard A. P., Witkamp, Theo D., van Nieuwenhuizen, Koen M., de Leeuw, Frank-Erik, Schonewille, Wouter J., de Kort, Paul L. M., Dippel, Diederik W. J., Raaymakers, Theodora W. M., Hofmeijer, Jeannette, Wermer, Marieke J. H., Kerkhoff, Henk, Jellema, Korné, Bronner, Irene M., Remmers, Michel J. M., Bienfait, Henri Paul, Witjes, Ron J. G. M., Jäger, H. Rolf, Greving, Jacoba P., Klijn, Catharina J. M., Boogaarts, H. B., van Dijk, E. J., Schonewille, W. J., Pellikaan, W. M. J., Puppels-de Waard, C., de Kort, P. L. M., Peluso, J. P., van Tuijl, J. H., Hofmeijer, J., Joosten, F. B. M., Dippel, D. W., Khajeh, L., Raaijmakers, T. W. M., Wermer, M. J., van Walderveen, M. A., Kerkhoff, H., Zock, E., Jellema, K., Lycklama, G. J., Bronner, I. M., Remmers, M. J. M., Witjes, R. J. G. M., Bienfait, H. P., Droogh-Greve, K. E., Donders, R. C. J. M., Kwa, V. I. H., Schreuder, T. H., Franke, C. L., Straver, J. S., Jansen, C., Bakker, S. L. M., Pleiter, C. C., Visser, M. C., van Asch, C. J. J., Velthuis, B. K., Rinkel, G. J. E., van Nieuwenhuizen, K. M., Klijn, C. J. M., Neurology, and Amsterdam Neuroscience - Neurovascular Disorders

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Computed Tomography Angiography, Clinical Neurology, Logistic regression, Magnetic resonance angiography, 03 medical and health sciences, Young Adult, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Predictive Value of Tests, Risk Factors, Internal medicine, Non traumatic, medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, Prospective Studies, Aged, Cerebral Hemorrhage, Netherlands, Central Nervous System Vascular Malformations, Prediction score, medicine.diagnostic_test, business.industry, Arteriovenous malformation, Digital subtraction angiography, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], nervous system diseases, Cerebral Angiography, Psychiatry and Mental health, Logistic Models, Cohort, Angiography, Cardiology, Surgery, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Magnetic Resonance Angiography
Abstract

ObjectiveA substantial part of non-traumatic intracerebral haemorrhages (ICH) arises from a macrovascular cause, but there is little guidance on selection of patients for additional diagnostic work-up. We aimed to develop and externally validate a model for predicting the probability of a macrovascular cause in patients with non-traumatic ICH.MethodsThe DIagnostic AngioGRAphy to find vascular Malformations (DIAGRAM) study (n=298; 69 macrovascular cause; 23%) is a prospective, multicentre study assessing yield and accuracy of CT angiography (CTA), MRI/ magnetic resonance angiography (MRA) and intra-arterial catheter angiography in diagnosing macrovascular causes in patients with non-traumatic ICH. We considered prespecified patient and ICH characteristics in multivariable logistic regression analyses as predictors for a macrovascular cause. We combined independent predictors in a model, which we validated in an external cohort of 173 patients with ICH (78 macrovascular cause, 45%).ResultsIndependent predictors were younger age, lobar or posterior fossa (vs deep) location of ICH, and absence of small vessel disease (SVD). A model that combined these predictors showed good performance in the development data (c-statistic 0.83; 95% CI 0.78 to 0.88) and moderate performance in external validation (c-statistic 0.66; 95% CI 0.58 to 0.74). When CTA results were added, the c-statistic was excellent (0.91; 95% CI 0.88 to 0.94) and good after external validation (0.88; 95% CI 0.83 to 0.94). Predicted probabilities varied from 1% in patients aged 51–70 years with deep ICH and SVD, to more than 50% in patients aged 18–50 years with lobar or posterior fossa ICH without SVD.ConclusionThe DIAGRAM scores help to predict the probability of a macrovascular cause in patients with non-traumatic ICH based on age, ICH location, SVD and CTA.

Published
2017

7. Temporal profile of body temperature in acute ischemic stroke : Relation to infarct size and outcome

Author

Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., and van der Graaf, Y.

Published
2016

8. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

Author

Opleiding Neurologie, Brain, Arts-assistenten Radiologie, ZL Algemene Neurologie Medisch, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, MS Radiologie, Cancer, Onderzoek Beeld, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Opleiding Neurologie, Brain, Arts-assistenten Radiologie, ZL Algemene Neurologie Medisch, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, MS Radiologie, Cancer, Onderzoek Beeld, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., and van der Graaf, Y.

Published
2016

9. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

Author

Van Seeters, Tom, Biessels, Geert J., van der Schaaf, Irene C., Dankbaar, Jan W., Horsch, Alexander D., Luitse, Merel J.A., Niesten, Joris M., Mali, Willem P.T.M., Kappelle, L. J., van der Graaf, Yolanda, Velthuis, Birgitta K., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklamaà Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Neurology, Public Health, Radiology and nuclear medicine, and Public and occupational health

Subjects
medicine.medical_specialty, Infarct, Clinical Neurology, Perfusion scanning, Ischaemia, Brain Ischemia, Cohort Studies, Study Protocol, Modified Rankin Scale, Predictive Value of Tests, medicine, Humans, Prospective Studies, Stage (cooking), Prospective cohort study, Stroke, Netherlands, Receiver operating characteristic, medicine.diagnostic_test, business.industry, General Medicine, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Cerebral Angiography, Perfusion, Treatment Outcome, CT angiography, Predictive value of tests, Angiography, CT perfusion, Neurology (clinical), Radiology, business, Prediction, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

Contains fulltext : 136571.pdf (Publisher’s version ) (Open Access) BACKGROUND: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated. METHODS/DESIGN: The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests. DISCUSSION: This study will provide insight in the added prognostic value of CTP and CTA parameters in outcome prediction of acute stroke patients. The prediction models that will be developed in this study may help guide future treatment decisions in the acute stage of ischaemic stroke.

Published
2014

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