{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T15:41:09Z","timestamp":1793115669704,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,19]]},"abstract":"\n Background<\/jats:title>\n Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large\u2010vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large\u2010vessel occlusion regardless of reperfusion therapy.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Consecutive acute ischemic stroke patients with anterior large\u2010vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion\u2010Weighted Imaging\u2010Alberta Stroke Program Early Computed Tomography Score (DWI\u2010ASPECTS) and diffusion\u2010weighted imaging lesion ischemic core volume (Vol\n \n DWI<\/jats:sub>\n <\/jats:styled-content>\n ) were measured in acute ischemic stroke patients with large\u2010vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3\u00a0months, and optimal\n DWI<\/jats:styled-content>\n \u2010\n ASPECTS<\/jats:styled-content>\n and Vol\n \n DWI<\/jats:sub>\n <\/jats:styled-content>\n for unfavorable outcome were assessed. In total, 198 patients (111 men, 77\u00b113\u00a0years old) were enrolled. Median\n DWI<\/jats:styled-content>\n \u2010\n ASPECTS<\/jats:styled-content>\n was 7 (5\u20109), and median Vol\n \n DWI<\/jats:sub>\n <\/jats:styled-content>\n was 55 (6\u2010134)\n mL<\/jats:styled-content>\n . Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for\n DWI<\/jats:styled-content>\n \u2010\n ASPECTS<\/jats:styled-content>\n and Vol\n \n DWI<\/jats:sub>\n <\/jats:styled-content>\n were 4 (area under the curve 0.78,\n P<\/jats:italic>\n <0.01; sensitivity 0.71, specificity 0.75) and 71\u00a0mL (area under the curve 0.80,\n P<\/jats:italic>\n <0.01; sensitivity 0.76, specificity 0.77), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The cutoff values for our redefined malignant profile were\n DWI<\/jats:styled-content>\n \u2010\n ASPECTS<\/jats:styled-content>\n 4 and Vol\n \n DWI<\/jats:sub>\n <\/jats:styled-content>\n 71\u00a0mL with no selection bias for reperfusion therapy in the real\u2010world clinical practice.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n Unique identifier:\n NCT<\/jats:styled-content>\n 02251665\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.012558","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T15:14:11Z","timestamp":1573226051000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":58,"title":["Use of Diffusion\u2010Weighted Imaging\u2010Alberta Stroke Program Early Computed Tomography Score (DWI\u2010ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke"],"prefix":"10.1161","volume":"8","author":[{"given":"Takeshi","family":"Yoshimoto","sequence":"first","affiliation":[{"name":"Department of Neurology National Cerebral and Cardiovascular Center Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan"},{"name":"Division 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Sonoda","sequence":"additional","affiliation":[{"name":"Division of Stroke Care Unit National Cerebral and Cardiovascular Center Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naruhiko","family":"Kamogawa","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Ihara","sequence":"additional","affiliation":[{"name":"Department of Neurology National Cerebral and Cardiovascular Center Suita 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Thrombolysis with alteplase 3 to 4.5\u00a0hours after acute ischemic stroke. N Engl J Med. 2007;358:1327\u20131335.","journal-title":"N Engl J Med"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2009.190140"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003047"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30314-4"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.618355"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X15610586"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.119.012558","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:24:04Z","timestamp":1715599444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.012558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,19]]},"references-count":22,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2019,11,19]]}},"alternative-id":["10.1161\/JAHA.119.012558"],"URL":"https:\/\/doi.org\/10.1161\/jaha.119.012558","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,19]]},"assertion":[{"value":"2019-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e012558"}}