Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial DUST study protocolReportar como inadecuado

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BMC Neurology

, 14:37

Cerebrovascular disease and stroke


BackgroundPrediction 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-designThe 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.

DiscussionThis 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.

KeywordsStroke Ischaemia Infarct Prediction CT perfusion CT angiography AbbreviationsASPECTSAlberta stroke program early CT score

AUCArea under the curve

CBFCerebral blood flow

CBVCerebral blood volume

CTACT angiography

CTA-SICTA source images

CTPCT perfusion

DUSTDutch acute stroke trial

IATIntra-arterial thrombolysis

IV-rtPAIntravenous recombinant tissue type plasminogen activator

MIPMaximum intensity projection

mRSModified Rankin scale

MTTMean transit time

MPRMultiplanar reconstruction

NCCTNon-contrast computed tomography

NIHSSNational institutes of health stroke scale

pcASPECTSPosterior circulation ASPECTS

ROCReceiver operator characteristics

TTPTime to peak.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-14-37 contains supplementary material, which is available to authorized users.

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Autor: Tom van Seeters - Geert Jan Biessels - Irene C van der Schaaf - Jan Willem Dankbaar - Alexander D Horsch - Merel JA Lui


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