Automated CT Perfusion Imaging Versus Non-contrast CT for Ischemic Core Assessment in Large Vessel Occlusion

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2018 Nov 25

PMID 30470847

Citations 10

Authors

Anderson Chun On Tsang

Stephanie Lenck

Christopher Hilditch

Patrick Nicholson

Waleed Brinjikji

Timo Krings

Vitor M Pereira

Frank L Silver

Joanna D Schaafsma

Affiliations

Soon will be listed here.

Abstract

Purpose: There is increasing use of automated computed tomography perfusion (CTP) to aid thrombectomy decision in emergent large vessel occlusion. It is important to understand the performance of these software packages in predicting ischemic core and tissue-at-risk in the real-world setting. The aim of this study was to evaluate whether ischemic core on non-contrast CT (NCCT) and automated CTP correspond and predict infarct extent after thrombectomy for ischemic stroke.

Methods: Consecutive patients with acute anterior circulation large vessel occlusion undergoing successful thrombectomy (TICI 2b/3) were studied. All patients had baseline CT, CTP with RAPID post-processing software (RAPID-CTP), and post-thrombectomy 24 h CT. Ischemic cores were assessed by two blinded raters independently using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on each modality. The interrater agreement for ASPECTS, and correlation between baseline CT-ASPECTS, RAPID-CTP-ASPECTS, and 24h CT-ASPECTS were calculated.

Results: A total of 86 patients with a mean age of 70.3 years (SD 16.5) were studied. The median baseline CT-ASPECTS was 9.5 (interquartile range, IQR 8-10), median RAPID-CTP-ASPECTS was 9 (IQR 8-10), and mean RAPID-CTP-ischemic core volume was 14.4 ml (SD 27.9 ml). The mean mismatch volume (difference of Tmax > 6s and cerebral blood flow (CBF) < 30%) was 128.6 ml (SD 126.0 ml). There was substantial correlation between baseline and 24h CT-ASPECTS (r: 0.62; p < 0.001), but poor correlation between RAPID-CTP-ASPECTS and RAPID-CTP ischemic core volume with 24h NCCT-ASPECTS (r: 0.21; p = 0.06 and -0.16; p = 0.15 respectively). The positive predictive value of any established infarct for baseline CT-ASPECTS was 81%, while that of RAPID-CTP-ASPECTS was 64%.

Conclusion: In this series of successfully revascularized patients, ischemic core as estimated by RAPID-CTP-ASPECTS did not correlate with the baseline CT and tended to depict a larger infarct core than the infarct extent as assessed by 24h CT-ASPECTS.

Citing Articles

Application of imaging modalities for endovascular thrombectomy of large core infarcts in clinical practice.

Zeng H, Zhu Q Front Neurol. 2024; 15:1272890.

PMID: 38665995 PMC: 11043533. DOI: 10.3389/fneur.2024.1272890.

Software with artificial intelligence-derived algorithms for analysing CT brain scans in people with a suspected acute stroke: a systematic review and cost-effectiveness analysis.

Westwood M, Ramaekers B, Grimm S, Armstrong N, Wijnen B, Ahmadu C Health Technol Assess. 2024; 28(11):1-204.

PMID: 38512017 PMC: 11017149. DOI: 10.3310/RDPA1487.

Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties.

Fainardi E, Busto G, Morotti A Eur J Radiol Open. 2023; 11:100524.

PMID: 37771657 PMC: 10523426. DOI: 10.1016/j.ejro.2023.100524.

Thrombectomy with and without computed tomography perfusion imaging for large-vessel occlusion stroke in the extended time window: a meta-analysis of randomized clinical trials.

Zhan Z, Gu F, Ji Y, Zhang Y, Ge Y, Wang Z Front Neurol. 2023; 14:1185554.

PMID: 37669248 PMC: 10470654. DOI: 10.3389/fneur.2023.1185554.

Diagnosis of Ischemic Stroke: As Simple as Possible.

Malikova H, Weichet J Diagnostics (Basel). 2022; 12(6).

PMID: 35741262 PMC: 9221735. DOI: 10.3390/diagnostics12061452.

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