TY - JOUR
T1 - Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography
T2 - The Dutch acute stroke trial (DUST) study protocol
AU - van Seeters, Tom
AU - Biessels, Geert J.
AU - van der Schaaf, Irene C.
AU - Dankbaar, Jan W.
AU - Horsch, Alexander D.
AU - Luitse, Merel J.A.
AU - Niesten, Joris M.
AU - Mali, Willem P.T.M.
AU - Kappelle, L. Jaap
AU - van der Graaf, Yolanda
AU - Velthuis, Birgitta K.
AU - Majoie, C.B.
AU - Roos, Y.B.
AU - Duijm, L.E.
AU - Keizer, K.
AU - van der Lugt, A.
AU - Dippel, D.W.
AU - Droogh-de Greeve, K.E.
AU - Bienfait, H.P.
AU - van Walderveen, M.A.
AU - Wermer, M.J.
AU - Lycklama à Nijeholt, G. J.
AU - Boiten, J.
AU - Duyndam, D.
AU - Kwa, V.I.
AU - Meijer, F.J.
AU - van Dijk, E.J.
AU - Kesselring, F.O.
AU - Hofmeijer, J.
AU - Vos, J.A.
AU - Schonewille, W.J.
AU - van Rooij, W.J.
AU - de Kort, P.L.
AU - Pleiter, C.C.
AU - Bakker, S.L.
AU - Bot, J.
AU - Visser, M.C.
AU - DUST investigators
N1 - Funding Information:
This study was supported by a grant from the Dutch Heart Foundation (grant number 2008 T034) and the Nuts Ohra Foundation (grant number 0903–012). The funders had no role in study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.
PY - 2014/2/25
Y1 - 2014/2/25
N2 - 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.
AB - 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.
KW - CT angiography
KW - CT perfusion
KW - Infarct
KW - Ischaemia
KW - Prediction
KW - Stroke
UR - https://www.scopus.com/pages/publications/84896706852
U2 - 10.1186/1471-2377-14-37
DO - 10.1186/1471-2377-14-37
M3 - Article
C2 - 24568540
AN - SCOPUS:84896706852
SN - 1471-2377
VL - 14
JO - BMC neurology
JF - BMC neurology
IS - 1
M1 - 37
ER -
SDG 3 Good Health and Well-being