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dc.contributor.authorNagenthiraja, Kartheebanen_US
dc.contributor.authorWalcott, Brian P.en_US
dc.contributor.authorHansen, Mikkel B.en_US
dc.contributor.authorØstergaard, Leifen_US
dc.contributor.authorMouridsen, Kimen_US
dc.date.accessioned2014-03-10T20:34:19Z
dc.date.issued2013en_US
dc.identifier.citationNagenthiraja, Kartheeban, Brian P. Walcott, Mikkel B. Hansen, Leif Østergaard, and Kim Mouridsen. 2013. “Automated Decision-Support System for Prediction of Treatment Responders in Acute Ischemic Stroke.” Frontiers in Neurology 4 (1): 140. doi:10.3389/fneur.2013.00140. http://dx.doi.org/10.3389/fneur.2013.00140.en
dc.identifier.issn1664-2295en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11878942
dc.description.abstractMRI is widely used in the assessment of acute ischemic stroke. In particular, it identifies the mismatch between hypoperfused and the permanently damaged tissue, the PWI-DWI mismatch volume. It is used to help triage patients into active or supportive treatment pathways. COMBAT Stroke is an automated software tool for estimating the mismatch volume and ratio based on MRI. Herein, we validate the decision made by the software with actual clinical decision rendered. Furthermore, we evaluate the association between treatment decisions (both automated and actual) and outcomes. COMBAT Stroke was used to determine PWI-DWI mismatch volume and ratio in 228 patients from two European multi-center stroke databases. We performed confusion matrix analysis to summarize the agreement between the automated selection and the clinical decision. Finally, we evaluated the clinical and imaging outcomes of the patients in the four entries of the confusion matrix (true positive, true negative, false negative, and false positive). About 186 of 228 patients with acute stroke underwent thrombolytic treatment, with the remaining 42 receiving supportive treatment only. Selection based on radiographic criteria using COMBAT Stroke classified 142 patients as potential candidates for thrombolytic treatment and 86 for supportive treatment; 60% sensitivity and 29% specificity. The patients deemed eligible for thrombolytic treatment by COMBAT Stroke demonstrated significantly higher rates of compromised tissue salvage, less neurological deficit, and were more likely to experience thrombus dissolving and reestablishment of normal blood flow at 24 h follow-up compared to those who were treated without substantial PWI-DWI mismatch. These results provide evidence that COMBAT Stroke, in addition to clinical assessment, may offer an optimal framework for a fast, efficient, and standardized clinical support tool to select patients for thrombolysis in acute ischemic stroke.en
dc.language.isoen_USen
dc.publisherFrontiers Media S.A.en
dc.relation.isversionofdoi:10.3389/fneur.2013.00140en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783931/pdf/en
dash.licenseLAAen_US
dc.subjectstrokeen
dc.subjectbrain edemaen
dc.subjectmagnetic resonance imagingen
dc.subjectbrain ischemiaen
dc.subjectdecision-support systemsen
dc.subjectclinicalen
dc.subjectthrombolytic therapyen
dc.titleAutomated Decision-Support System for Prediction of Treatment Responders in Acute Ischemic Strokeen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalFrontiers in Neurologyen
dash.depositing.authorWalcott, Brian P.en_US
dc.date.available2014-03-10T20:34:19Z
dc.identifier.doi10.3389/fneur.2013.00140*
dash.contributor.affiliatedWalcott, Brian


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