title: RAPID automated patient selection for reperfusion therapy: a pooled analysis of the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study.
abstract: OBJECTIVE
  The aim of this study was to determine if automated MRI analysis software (RAPID) can be used to identify patients with stroke in whom reperfusion is associated with an increased chance of good outcome.
  
  
  METHODS
  Baseline diffusion- and perfusion-weighted MRI scans from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution study (DEFUSE; n=74) and the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET; n=100) were reprocessed with RAPID. Based on RAPID-generated diffusion-weighted imaging and perfusion-weighted imaging lesion volumes, patients were categorized according to 3 prespecified MRI profiles that were hypothesized to predict benefit (Target Mismatch), harm (Malignant), and no effect (No Mismatch) from reperfusion. Favorable clinical response was defined as a National Institutes of Health Stroke Scale score of 0 to 1 or a ≥ 8-point improvement on the National Institutes of Health Stroke Scale score at Day 90.
  
  
  RESULTS
  In Target Mismatch patients, reperfusion was strongly associated with a favorable clinical response (OR, 5.6; 95% CI, 2.1 to 15.3) and attenuation of infarct growth (10 ± 23 mL with reperfusion versus 40 ± 44 mL without reperfusion; P<0.001). In Malignant profile patients, reperfusion was not associated with a favorable clinical response (OR, 0.74; 95% CI, 0.1 to 5.8) or attenuation of infarct growth (85 ± 74 mL with reperfusion versus 95 ± 79 mL without reperfusion; P=0.7). Reperfusion was also not associated with a favorable clinical response (OR, 1.05; 95% CI, 0.1 to 9.4) or attenuation of lesion growth (10 ± 15 mL with reperfusion versus 17 ± 30 mL without reperfusion; P=0.9) in No Mismatch patients.
  
  
  CONCLUSIONS
  MRI profiles that are associated with a differential response to reperfusion can be identified with RAPID. This supports the use of automated image analysis software such as RAPID for patient selection in acute stroke trials.
authors.affiliation: Stanford University,Stanford Stroke Center, 780 Welch Road, Suite 205, Palo Alto, CA 94304, USA. lansberg@stanford.edu
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.forename: Soren
authors.initials: S
authors.lastname: Christensen
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.forename: Deidre A
authors.initials: DA
authors.lastname: De Silva
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Campbell
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Patricia
authors.initials: P
authors.lastname: Desmond
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
mesh_terms: D002986:Clinical Trials as Topic; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018579:Patient Selection; D055420:Perfusion Imaging / Q000379:methods*; D015424:Reperfusion; D012984:Software; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents