Association between perihematomal cerebral blood volume and intracerebral hemorrhage expansion: A computed tomography perfusion study

2019 ◽  
Vol 85 (6) ◽  
pp. 943-947 ◽  
Author(s):  
Andrea Morotti ◽  
Giorgio Busto ◽  
Andrea Bernardoni ◽  
Carmine Tamborino ◽  
Enrico Fainardi
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Perfusion Study ◽  
Computed Tomography Perfusion

scholarly journals Accuracy and reliability of PBV ASPECTS, CBV ASPECTS and NCCT ASPECTS in acute ischaemic stroke: a matched-pair analysis

2021 ◽  
pp. 197140092110157
Author(s):  
Arne Potreck ◽  
Alina Falbesaner ◽  
Fatih Seker ◽  
Charlotte S Weyland ◽  
Sibu Mundiyanapurath ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Matched Pair ◽  
Stroke Severity ◽  
Computed Tomography Perfusion ◽  
Matched Pair Analysis ◽  
Pair Analysis

Background and purpose To investigate the reliability and accuracy of Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) derived from flatpanel detector computed tomography pooled blood volume maps compared to non-contrast computed tomography and multidetector computed tomography perfusion cerebral blood volume maps. Methods ASPECTS from pooled blood volume maps were evaluated retrospectively by two experienced readers for 37 consecutive patients with acute middle cerebral artery (MCA) M1 occlusion who underwent flatpanel detector computed tomography perfusion imaging before mechanical thrombectomy between November 2016 and February 2019. For comparison with ASPECTS from non-contrast computed tomography and cerebral blood volume maps, a matched-pair analysis according to pre-stroke modified Rankin scale, age, stroke severity, site of occlusion, time from stroke onset to imaging and final modified thrombolysis in cerebral infarction (mTICI) was performed in a separate group of patients who underwent multimodal computed tomography prior to mechanical thrombectomy between June 2015 and February 2019. Follow-up ASPECTS were derived from either non-contrast computed tomography or from magnetic resonance imaging (in seven patients) one day after mechanical thrombectomy. Results Interrater agreement was best for non-contrast computed tomography ASPECTS (w-kappa = 0.74, vs. w-kappa = 0.63 for cerebral blood volume ASPECTS and w-kappa = 0.53 for pooled blood volume ASPECTS). Also, accuracy, defined as correlation between acute and follow-up ASPECTS, was best for non-contrast computed tomography ASPECTS (Spearman ρ = 0.86 (0.65–0.97), P < 0.001), while it was lower and comparable for pooled blood volume ASPECTS (ρ = 0.58 (0.32–0.79), P < 0.001) and cerebral blood volume ASPECTS (ρ = 0.52 (0.17–0.80), P = 0.001). It was noteworthy that cases of relevant infarct overestimation by two or more ASPECTS regions (compared to follow-up imaging) were observed for both acute pooled blood volume and cerebral blood volume ASPECTS but occurred more often for acute pooled blood volume ASPECTS (25% vs. 5%, P = 0.02). Conclusion Non-contrast computed tomography ASPECTS outperformed both pooled blood volume ASPECTS and cerebral blood volume ASPECTS in accuracy and reliability. Importantly, relevant infarct overestimation was observed more often in pooled blood volume ASPECTS than cerebral blood volume ASPECTS, limiting its present clinical applicability for acute stroke imaging.

LOWER PRETREATMENT CEREBRAL BLOOD VOLUME AFFECTS HEMORRHAGIC RISKS AFTER INTRA-ARTERIAL REVASCULARIZATION IN ACUTE STROKE

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 874-879 ◽  
Author(s):  
Archit Bhatt ◽  
Nirav A. Vora ◽  
Ajith J. Thomas ◽  
Arshad Majid ◽  
Mounzer Kassab ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Blood Volume ◽  
Intracranial Hemorrhage ◽  
Cerebral Blood Volume ◽  
Michigan State University ◽  
State University ◽  
University Of Pittsburgh ◽  
Computed Tomography Perfusion ◽  
The University

Abstract OBJECTIVE Intra-arterial therapies are being used more frequently in patients presenting with acute cerebral occlusions, but they have been limited by the potential for hemorrhage. We sought to determine whether pretreatment computed tomography perfusion parameters might help to identify patients at a higher risk of developing intracranial hemorrhage after intra-arterial stroke revascularization treatment. METHODS We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University who underwent computed tomography perfusion imaging of the brain before intra-arterial thrombolysis between January 2006 and June 2007. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the independent predictors of developing intracranial hemorrhage. RESULTS A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 ± 13 years and mean National Institutes of Health Stroke Scale scores of 16 ± 5 were studied. The overall recanalization (Thrombolysis in Myocardial Infarction Trial scale 2 or 3 flow) was 72% for the cohort, and the overall rate of parenchymal hemorrhage was 5 of 57 (9%) patients. The overall hemorrhage rate was 19 of 57 (33%) patients. The only variable found to be predictive of the development of hemorrhage after intervention was reduced pretreatment cerebral blood volume (odds ratio, 0.49; 95% confidence interval, 0.35–0.91; P &lt; 0.022). CONCLUSION A reduced pretreatment ipsilateral cerebral blood volume value before endovascular revascularization of an acute middle cerebral artery or internal carotid artery occlusion significantly increases the risk of an intracranial hemorrhage.

scholarly journals Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

2019 ◽  
Vol 32 (4) ◽  
pp. 277-286 ◽  
Author(s):  
Daniel Weiss ◽  
Bastian Kraus ◽  
Christian Rubbert ◽  
Marius Kaschner ◽  
Sebastian Jander ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Favourable Outcome ◽  
Index Score ◽  
Modified Rankin Scale ◽  
Rater Reliability ◽  
Endovascular Thrombectomy ◽  
Computed Tomography Perfusion

Purpose This study compares computed tomography angiography-based collateral scoring systems in regard to their inter-rater reliability and potential to predict functional outcome after endovascular thrombectomy, and relates them to parenchymal perfusion as measured by computed tomography perfusion. Methods Eighty-four patients undergoing endovascular thrombectomy in anterior circulation ischaemic stroke were enrolled. Modified Tan Score, Miteff Score, Maas Score and Opercular Index Score ratio were assessed in pre-interventional computed tomography angiographies independently by two readers. Collateral scores were tested for inter-rater reliability by weighted-kappa, for correlations with three-months modified Rankin Scale, and their potential to differentiate between patients with favourable (modified Rankin Scale ≤2) and poor outcome (modified Rankin Scale ≥3). Correlations with relative cerebral blood volume and relative cerebral blood flow were tested in patients with available computed tomography perfusion. Results Very good inter-rater reliability was found for Modified Tan, Miteff and Opercular Index Score ratio, and substantial reliability for Maas. There were no significant correlations between collateral scores and three-months modified Rankin Scale, but significant group differences between patients with favourable and poor outcome for Maas, Miteff and Opercular Index Score ratio. Miteff and Maas were significant predictors of favourable outcome in binary logistic regression analysis. Miteff best differentiated between both outcome groups in receiver-operating characteristics, and Maas reached highest sensitivity for favourable outcome prediction of 96%. All collateral scores significantly correlated with mean relative cerebral blood volume and relative cerebral blood flow. Conclusions Computed tomography angiography scores are valuable in estimating functional outcome after mechanical thrombectomy and reliable across readers. The more complex scores, Maas and Miteff, show the best performances in predicting favourable outcome.

scholarly journals Perfusion computed tomography of intracranial meningiomas: In vivo correlation of cerebral blood volume and vascular permeability

2015 ◽  
Vol 28 (3) ◽  
pp. 303-309 ◽  
Author(s):  
Francesca Granata ◽  
Rosa Morabito ◽  
Concetta Alafaci ◽  
Valeria Barresi ◽  
Francesco Tomasello ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vascular Permeability ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Perfusion Computed Tomography ◽  
Intracranial Meningiomas

scholarly journals Computed tomography perfusion-based selection of endovascularly treated acute ischaemic stroke patients – Are there lessons to be learned from the pre-evidence era?

2017 ◽  
Vol 30 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Marios-Nikos Psychogios ◽  
Michael Knauth ◽  
Raya Bshara ◽  
Katharina Schregel ◽  
Ioannis Tsogkas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Patient Selection ◽  
Cerebral Blood Volume ◽  
Selection Criterion ◽  
Favourable Outcome ◽  
Cranial Computed Tomography ◽  
Therapeutic Window ◽  
Published Data ◽  
Stroke Patients ◽  
Computed Tomography Perfusion

Introduction Some of the latest groundbreaking trials suggest that noncontrast cranial computed tomography and computed tomography-angiography are sufficient tools for patient selection within six hours of symptom onset. Before endovascular stroke therapy became the standard of care, patient selection was one of the most useful tools to avoid futile reperfusions. We report the outcomes of endovascularly treated stroke patients selected with a perfusion-based paradigm and discuss the implications in the current era of endovascular treatment. Material and methods After an interdisciplinary meeting in September 2012 we agreed to select thrombectomy candidates primarily based on computed tomography perfusion with a cerebral blood volume Alberta Stroke Program Early Computed Tomography Scale (CBV-ASPECTS) of <7 being a strong indicator of futile reperfusion. In this study, we retrospectively screened all patients with an M1 thrombosis in our neurointerventional database between September 2012 and December 2014. Results In 39 patients with a mean age of 69 years and a median admission National Institute of Health Stroke Scale of 17 the successful reperfusion rate was 74% and the favourable outcome rate at 90 days was 56%. Compared to previously published data from our database 2007–2011, we found that a two-point increase in median CBV-ASPECTS was associated with a significant increase in favourable outcomes. Conclusion Computed tomography perfusion imaging as an additional selection criterion significantly increased the rate of favourable clinical outcome in patients treated with mechanical thrombectomy. Although computed tomography perfusion has lost impact within the six-hour period, we still use it in cases beyond six hours as a means to broaden the therapeutic window.

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