Outcomes of Symptomatic Anterior Large Vessel Occlusion by Initial Imaging Assessment Using Diffusion‐Weighted Imaging Versus Noncontrast Computed Tomography
Bibliographic record
Abstract
Background We aimed to compare outcomes after stroke due to anterior circulation large vessel occlusion with initial imaging assessments using diffusion‐weighted imaging (DWI) or noncontrast computed tomography (NCCT). Methods Among 2399 patients with large vessel occlusion stroke in a prospective, multicenter registry, patients with (1) prestroke modified Rankin Scale scores 0 to 1, (2) occlusion of the internal carotid artery or M1 segment of the middle cerebral artery, and (3) onset‐to‐hospital‐arrival time <6 hours were included. The primary effectiveness outcome was good functional outcome, defined as modified Rankin Scale scores 0 to 2 at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. Intergroup biases were accounted for by mixed‐effects multivariable modeling and inverse probability of treatment weighting. Results A total of 343 patients (130 women [37.9%]; median age, 74 years [interquartile range, IQR, 66–82 years]) were analyzed. DWI‐based assessment was performed in 217 patients, and NCCT‐based assessment was performed in 126 patients. The DWI group showed a lower baseline National Institutes of Health Stroke Scale score ( P <0.01) and lower Alberta Stroke Program Early CT Score ( P <0.01) than the NCCT group. Frequency of endovascular therapy was lower in the DWI group (71.9%) than in the NCCT group (84.1%; P <0.01). Median hospital‐arrival‐to‐arterial‐puncture time was 55 minutes (IQR, 40–77.5 minutes) in the DWI group and 55 minutes (IQR, 35–80 minutes) in the NCCT group ( P =0.89), with similar rates of successful recanalization (77.6% versus 76.4%, respectively; P =0.88). Frequency of good functional outcome was 47.0% in the DWI group and 41.3% in the NCCT group (adjusted odds ratio, 1.32; 95% CI, 0.49–3.55). Symptomatic intracranial hemorrhage was encountered in 2.8% in the DWI group and 1.6% in the NCCT group ( P =0.71). Conclusions Potential difference in accuracy of ischemic damage assessment between the 2 modalities did not seem to affect outcomes of anterior circulation large vessel occlusion stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".