Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke.

IF 4.5 1区医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2025-03-17 DOI:10.1136/jnis-2024-021536

Christopher G Favilla, Grayson L Baird, Kedar Grama, Soren Konecky, Sarah Carter, Wendy Smith, Rebecca Gitlevich, Alexa Lebron-Cruz, Arjun G Yodh, Ryan A McTaggart

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Abstract

Background: Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO.

Methods: Patients were prospectively enrolled at two comprehensive stroke centers during stroke alert evaluation within 24 hours of onset with National Institutes of Health Stroke Scale (NIHSS) score ≥2. A 70 s bedside optical blood flow scan generated cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was determined by CT angiography. A deep learning model trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. Receiver operating characteristic (ROC) analysis compared the Openwater diagnostic performance (ie, LVO detection) with prehospital stroke scales.

Results: Among 135 patients, 52 (39%) had an anterior circulation LVO. The median NIHSS score was 8 (IQR 4-14). The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The rapid arterial occlusion evaluation (RACE) scale had 60% sensitivity and 81% specificity and the Los Angeles motor scale (LAMS) had 50% sensitivity and 81% specificity. The binary Openwater classification (high-likelihood vs low-likelihood) had an area under the ROC (AUROC) of 0.82 (95% CI 0.75 to 0.88), which outperformed RACE (AUC 0.70; 95% CI 0.62 to 0.78; P=0.04) and LAMS (AUC 0.65; 95% CI 0.57 to 0.73; P=0.002).

Conclusions: The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients undergoing acute stroke evaluation in the emergency department. These encouraging findings need to be validated in an independent test set and the prehospital environment.

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便携式脑血流监测仪，用于检测疑似中风患者的大血管闭塞情况。

背景：早期发现大血管闭塞（LVO）有助于将患者分流到合适的卒中中心，从而缩短治疗时间并改善预后。院前卒中量表的灵敏度不够，因此我们研究了便携式 Openwater 光学血流监测仪检测 LVO 的能力：方法：在两个综合卒中中心对发病 24 小时内、美国国立卫生研究院卒中量表 (NIHSS) 评分≥2 分的卒中患者进行卒中预警评估时，对患者进行前瞻性登记。70 秒床旁血流光学扫描根据斑点对比度的相对变化生成脑血流波形。通过 CT 血管造影确定前循环 LVO。深度学习模型通过五重交叉验证对所有患者数据进行训练，并从原始斑点对比度波形数据中学习判别表征。接收者操作特征（ROC）分析将开水诊断性能（即 LVO 检测）与院前卒中量表进行了比较：135 名患者中，52 人（39%）有前循环 LVO。NIHSS 评分中位数为 8（IQR 4-14）。开水仪器检测 LVO 的灵敏度为 79%，特异度为 84%。快速动脉闭塞评估量表（RACE）的灵敏度为 60%，特异度为 81%；洛杉矶运动量表（LAMS）的灵敏度为 50%，特异度为 81%。二元 Openwater 分类（高可能性 vs 低可能性）的 ROC (AUROC) 下面积为 0.82（95% CI 0.75 至 0.88），优于 RACE（AUC 0.70；95% CI 0.62 至 0.78；P=0.04）和 LAMS（AUC 0.65；95% CI 0.57 至 0.73；P=0.002）：结论：在对急诊科接受急性卒中评估的患者进行 LVO 检测时，开水式光学血流监测仪优于院前卒中量表。这些令人鼓舞的发现需要在独立的测试集和院前环境中进行验证。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.