{
  "abstract": "Background The ability to differentiate intracranial atherosclerotic disease (ICAD) related large vessel occlusion (LVO) from embolism is critical for stroke management. We hypothesized that the mismatch ratio derived from the automated computed tomography perfusion (CTP) could predict underlying ICAD.Methods Patients with acute ischemic stroke (AIS) and LVO from prospective registry databases who underwent CTP were included in the derivation cohort (n=1100). The mismatch ratio, calculated as the ratio of the hypo-perfused volume to the infarct core volume by software, was defined. Receiver Operating Characteristic (ROC) analysis was performed to assess the predictive performance of the mismatch ratio for ICAD, and logistic regression analysis was used to identify independent predictors of LVO associated with underlying ICAD. External validation was conducted using cohorts from two other stroke centers (n=385).Results In the derivation cohort, 390 patients were classified as ICAD and 720 as embolism. The ICAD group had a higher mismatch ratio (9.8 vs 3.6, P<0.001). The mismatch ratio outperformed age and National Institutes of Health Stroke Scale (NIHSS) score in predicting ICAD (area under the curve (AUC), 0.77 vs 0.36 vs 0.28, P<0.001). The ROC curve had a best cut-off of 7.1 for predicting ICAD, which was an independent predictor of ICAD-related occlusion (adjusted odds ratio (aOR) 5.43, 95% CI 3.68 to 8.03), with 68% sensitivity and 76% specificity. These results were validated in an external cohort (AUC=0.78; 95% CI, 0.73 to 0.83).Conclusion The perfusion mismatch ratio may be an optimal and simple predictor of anterior circulation ICAD- related LVO before endovascular treatment (EVT). When this ratio was ≥7.1, ICAD was five times more likely than embolism.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Tingyu Yi"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Zhi-nan Pan"
    },
    {
      "affiliations": [
        "Neurology, Fudan University Huashan Hospital Department of Neurology, Shanghai, Shanghai, China"
      ],
      "name": "Lan Hong"
    },
    {
      "affiliations": [
        "School of clinical medicine, Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Weifeng Huang"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Ding-lai Lin"
    },
    {
      "affiliations": [
        "Neurology, Fudan University Huashan Hospital Department of Neurology, Shanghai, Shanghai, China"
      ],
      "name": "Zhijiao He"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Shuyi Liu"
    },
    {
      "affiliations": [
        "Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Shujuan Gan"
    },
    {
      "affiliations": [
        "Neurology, Fushun Central Hospital, Fushun, LN, China, Fushun, Liaoning, China"
      ],
      "name": "Fenglong Lang"
    },
    {
      "affiliations": [
        "School of clinical medicine, Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Yi-ning Yang"
    },
    {
      "affiliations": [
        "School of clinical medicine, Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Jinhua Ye"
    },
    {
      "affiliations": [
        "School of clinical medicine, Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Huanghuang Chen"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, Beijing, China"
      ],
      "name": "Dapeng Sun"
    },
    {
      "affiliations": [
        "Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Huashan Hospital Fudan University, Shanghai, Shanghai, China"
      ],
      "name": "Xin Cheng"
    },
    {
      "affiliations": [
        "Neuro-intervention, Beijing Tiantan Hospital, Beijing, Beijing, China"
      ],
      "name": "Zhongrong Miao"
    },
    {
      "affiliations": [
        "Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Wen-huo Chen"
    }
  ],
  "title": "Diagnostic value of the perfusion mismatch ratio in identifying intracranial atherosclerotic disease related occlusion",
  "uid": "722b1447-7d3a-55f1-a808-9bb199dc7194"
}