Journal article

EPITHET Positive Result After Reanalysis Using Baseline Diffusion-Weighted Imaging/Perfusion-Weighted Imaging Co-Registration

Yoshinari Nagakane, Soren Christensen, Caspar Brekenfeld, Henry Ma, Leonid Churilov, Mark W Parsons, Christopher R Levi, Kenneth S Butcher, Andre Peeters, Alan Barber, Christopher F Bladin, Deidre A De Silva, John Fink, Thomas E Kimber, David W Schultz, Keith W Muir, Brian M Tress, Patricia M Desmond, Stephen M Davis, Geoffrey A Donnan



BACKGROUND AND PURPOSE: the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a prospective, randomized, double-blinded, placebo-controlled, phase II trial of alteplase between 3 and 6 hours after stroke onset. The primary outcome of infarct growth attenuation on MRI with alteplase in mismatch patients was negative when mismatch volumes were assessed volumetrically, without coregistration, which underestimates mismatch volumes. We hypothesized that assessing the extent of mismatch by coregistration of perfusion and diffusion MRI maps may more accurately allow the effects of alteplase vs placebo to be evaluated. METHODS: patients were classified as having mismatch if perfusion-we..

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