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@ARTICLE{Mundiyanapurath:130210,
      author       = {S. Mundiyanapurath and P. A. Ringleb and S. Diatschuk and
                      O. Eidel and S. Burth and R. O. Floca$^*$ and M.
                      Möhlenbruch and W. Wick$^*$ and M. Bendszus and A.
                      Radbruch$^*$},
      title        = {{T}ime-dependent parameter of perfusion imaging as
                      independent predictor of clinical outcome in symptomatic
                      carotid artery stenosis.},
      journal      = {BMC neurology},
      volume       = {16},
      number       = {1},
      issn         = {1471-2377},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2017-05290},
      pages        = {50},
      year         = {2016},
      abstract     = {Carotid artery stenosis is a frequent cause of ischemic
                      stroke. While any degree of stenosis can cause embolic
                      stroke, a higher degree of stenosis can also cause
                      hemodynamic infarction. The hemodynamic effect of a stenosis
                      can be assessed via perfusion weighted MRI (PWI). Our aim
                      was to investigate the ability of PWI-derived parameters
                      such as TTP (time-to-peak) and T(max) (time to the peak of
                      the residue curve) to predict outcome in patients with
                      unilateral acute symptomatic internal carotid artery (sICA)
                      stenosis.Patients with unilateral acute sICA stenosis
                      $(≥50\%$ according to NASCET), without intracranial
                      stenosis or occlusion, who underwent PWI, were included.
                      Clinical characteristics, volume of restricted diffusion,
                      volume of prolonged TTP and T(max) were retrospectively
                      analyzed and correlated with outcome represented by the
                      modified Rankin Scale (mRS) score at discharge. TTP and
                      T(max) volumes were dichotomized using a ROC curve analysis.
                      Multivariate analysis was performed to determine which
                      PWI-parameter was an independent predictor of
                      outcome.Thirty-two patients were included. Degree of
                      stenosis, volume of visually assessed TTP and volume of TTP
                      ≥2 s did not distinguish patients with favorable (mRS 0-2)
                      and unfavorable (mRS 3-6) outcome. In contrast, patients
                      with unfavorable outcome had higher volumes of TTP ≥4 s
                      (9.12 vs. 0.87 ml; p = 0.043), TTP ≥6 s (6.70 vs. 0.20
                      ml; p = 0.017), T(max) ≥4 s (25.27 vs. 0.00 ml;
                      p = 0.043), T(max) ≥6 s (9.21 vs. 0.00 ml;
                      p = 0.017), T(max) ≥8 s (6.86 vs. 0.00 ml;
                      p = 0.011) and T(max) ≥10s (5.94 vs. 0.00 ml;
                      p = 0.025) in univariate analysis. Multivariate logistic
                      regression showed that NIHSS score on admission (Odds Ratio
                      (OR) 0.466, confidence interval (CI) [0.224;0.971],
                      p = 0.041), T(max) ≥8 s (OR 0.025, CI [0.001;0.898]
                      p = 0.043) and TTP ≥6 s (OR 0.025, CI [0.001;0.898]
                      p = 0.043) were independent predictors of clinical
                      outcome.As they stood out in multivariate regression and are
                      objective and reproducible parameters, PWI-derived volumes
                      of T(max) ≥8 s and TTP ≥6 s might be superior to degree
                      of stenosis and visually assessed TTP maps in predicting
                      short term patient outcome. Future studies should assess if
                      perfusion weighted imaging might guide the selection of
                      patients for recanalization procedures.},
      cin          = {E071 / G370 / E012 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)E071-20160331 / I:(DE-He78)G370-20160331 /
                      I:(DE-He78)E012-20160331 / I:(DE-He78)L101-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27094741},
      pmc          = {pmc:PMC4837540},
      doi          = {10.1186/s12883-016-0576-5},
      url          = {https://inrepo02.dkfz.de/record/130210},
}