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Figures
- Fig 1.
A, Patient with left MCA stroke, NIHSS 4, and acute PCT showing an FHP corresponding to the clinical deficit (A1, MTT and A2, CBF). Subacute MR imaging at 3 days shows no DWI lesion (A3). B, A patient with right MCA stroke, NIHSS 6, and normal findings on acute PCT (B1, MTT and B2, CBF), but an acute DWI lesion at 1 day after admission (B3) corresponding to the clinical deficit. These examples convey the complementarity of acute PCT and MR imaging.
Tables
- Table 1:
Selected patient characteristics from the overall patient population and in patients with and without FHPa
Variable Population (n = 2216) FHP (n = 1624) No FHP (n = 592) Odds Ratio 95% CI Demographics Age (yr) 71.4 (20) 72 (19.5) 69.7 (21) 1.01b 1.00–1.01 Female sex 958 (43.3) 723 (44.6) 235 (39.8) 1.22b 1.01–1.48 Preexisting mRS score 0 (1) 0 (1) 0 (1) 0.96 0.87–1.05 Anticoagulation at onset 211 (9.6) 158 (9.8) 53 (9) 1.10 0.80–1.54 Clinical presentation Admission NIHSS (points) 8 (11) 10 (12) 4 (4) 1.21b 1.18–1.24 Aphasia 831 (38) 743 (46.4) 88 (15) 4.91b 3.85–6.32 Hemineglect 583 (26) 555 (35) 28 (4.8) 10.70b 7.36–16.2 Decreased level of consciousness 252 (11.6) 226 (14.3) 26 (4.5) 3.58b 2.40–5.55 Sensory deficit 1237 (56.9) 1021 (64.1) 216 (37.1) 3.03b 2.49–3.69 Visual field defect 882 (40.6) 836 (52.6) 46 (7.9) 13.00b 9.58–18.07 Stroke localization Pure posterior circulation 394 (18) 182 (11.3) 212 (36.9) 0.22b 0.17–0.27 Pure anterior circulation 1657 (75.4) 1393 (86.6) 254 (44.3) 8.12b 6.54–10.12 Stroke mechanism Atherosclerotic 301 (14.1) 249 (15.8) 52 (9.2) 1.87b 1.37–2.58 Cardioembolic 729 (34) 633 (40.2) 96 (16.9) 3.31b 2.61–4.23 Lacunar 238 (11.1) 42 (2.7) 196 (34.5) 0.05b 0.04–0.07 Risk factors Atrial fibrillation 619 (28) 536 (33.1) 83 (14) 3.03b 2.36–3.92 Hypercholesterolemia 1606 (73.1) 1147 (71.2) 459 (78) 0.70b 0.56–0.87 Acute CT imaging Onset-to-CT time (hr) 4.3 (10.4) 3.5 (8.6) 8.1 (12.9) 0.96b 0.95–0.97 Early ischemic changes on NCCT 831 (38.2) 771 (48.5) 60 (10.3) 8.20b 6.21–10.99 Arterial pathology in ischemic territory 242 (16.2) 237 (20.7) 5 (1.4) 18.01b 8.19–50.89 - Table 2:
Multivariate analysis of clinical and combined clinical and radiologic variables associated with FHP
Variables OR 95% CI Clinical predictors of FHP in MVA Admission NIHSS score 1.12 1.08–1.16 Visual field defects on admission 7.79 4.51–13.45 Aphasia at admission 2.03 1.37–3.00 Hemineglect at admission 4.50 2.46–8.22 Sensory deficit at admission 1.39 1.00–1.93 Decreased level of consciousness 6.32 2.49–16 Posterior circulation stroke 0.32 0.22–0.47 Lacunar stroke mechanism 0.14 0.08–0.24 Anticoagulation before stroke onset 0.45 0.28–0.72 Clinical and radiologic predictors of FHP in MVA Symptom onset-to-CT delay 0.97 0.95–0.99 Visual field defect at admission 6.09 3.43–10.81 Hemineglect at admission 4.13 2.06–8.27 Sensory deficit at admission 1.53 1.07–2.17 Cardioembolic stroke mechanism 1.87 1.11–3.13 Lacunar stroke mechanism 0.45 0.24–0.85 Early ischemic changes on CT 4.68 2.73–8.04 Chronic CT lesions (old strokes or leukoaraiosis) 0.54 0.33–0.87 Anterior circulation stroke 3.13 2.13–4.55 Arterial stenosis or occlusion in ischemic territory 2.29 1.32–3.99 - Table 3:
Accuracy of PCT as a diagnostic test for infarct identification on follow-up CT and MRI
n Test + n Test − Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) 95% CI Acute NCCT description (test) for any lesion at follow-up (condition) 673 880 43.3 96.6 98 23 51.2 (48.8–53.5) 9 258 PCT description (test) toward any lesion at follow-up (condition) 1260 313 80.1 57.9 91.2 33.9 67.9 (64.7–71.0) 117 161 PCT description (test) toward any lesion at MRI follow-up (condition) 516 260 66.5 79.4 96.2 22.8 76.8 (74.8–78.7) 20 77 Note:—PPV indicates positive predictive value; NPV, negative predictive value; +, positive; −, negative; n, number of patients.
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