scholarly journals Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2368-2375 ◽  
Author(s):  
Jan W. Hoving ◽  
Henk A. Marquering ◽  
Charles B.L.M. Majoie ◽  
Nawaf Yassi ◽  
Gagan Sharma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Spatial Accuracy ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Core Volume

Use of ABC/2 method for rapidly estimating the target mismatch on computed tomography perfusion imaging in patients with acute ischemic stroke

2021 ◽  
pp. 028418512110697
Author(s):  
Guang-Chen Shen ◽  
Yue Chu ◽  
Gao Ma ◽  
Xiao-Quan Xu ◽  
Shan-Shan Lu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Anterior Circulation ◽  
Computed Tomography Perfusion ◽  
Significant Difference ◽  
Feasible Alternative ◽  
Ischemic Core ◽  
The Difference

Background Target mismatch (ischemic core, mismatch volume and mismatch ratio) in patients with acute ischemic stroke (AIS) highly relies on the automated perfusion analysis software. Purpose To evaluate the feasibility and accuracy of using the ABC/2 method to rapidly estimate the target mismatch on computed tomography perfusion (CTP) imaging in patients with AIS, using RAPID results as a reference. Material and Methods In total, 243 patients with anterior circulation AIS who underwent CTP imaging were retrospectively reviewed. Target mismatch associated perfusion parameters were derived from RAPID results and calculated using the ABC/2 method. Paired t-test was used to assess the difference of volumetric parameters between the two methods. The ability of using the ABC/2 method to predict the important cutoff volumetric metrics was also evaluated. Result There was no significant difference in the volumes of ischemic core ( P = 0.068), ischemic area ( P = 0.209), and mismatch volume ( P = 0.518) between ABC/2 and RAPID. Using RAPID results as reference, the ABC/2 method showed high accuracy for predicting perfusion parameters (70 mL and 90 mL: sensitivity=98.5% and 98.5%, specificity=100% and 100%, positive predictive value [PPV]=100% and 100%, negative predictive value [NPV]=93.8% and 92.9%; 10 mL and 15mL: sensitivity=99.6% and 99.5%, specificity=55.6% and 50.0%, PPV=96.6% and 94.8%, NPV=90.9% and 92.3%; 1.2 and 1.8: sensitivity=99.6% and 94.8%, specificity=75.0% and 96.9%, PPV=98.7% and 99.5%, NPV=90.0% and 73.8%). Conclusion The ABC/2 method may be a feasible alternative to RAPID for estimation of target mismatch parameters on CTP in patients with AIS.

Value of pre-intervention computed tomography perfusion imaging in the assessment of tissue outcome and long-term clinical prognosis in patients with anterior circulation acute ischemic stroke receiving reperfusion therapy: a systematic review

2021 ◽  
pp. 028418512110358
Author(s):  
Anubhav Katyal ◽  
Sonu Menachem Maimonides Bhaskar
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Imaging Biomarkers ◽  
Cochrane Central Register ◽  
Clinical Prognosis ◽  
Computed Tomography Perfusion

Background Computed tomography perfusion (CTP) imaging has emerged as an important adjunct to the current armamentarium of acute ischemic stroke (AIS) workflow. However, its adoption in routine clinical practice is far from optimal. Purpose To investigate the putative association of CTP imaging biomarkers in the assessment of prognosis in acute ischemic stroke. Material and Methods We performed a systematic review of the literature using MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials focusing on CTP biomarkers, tissue-based and clinical-based patient outcomes. We included randomized controlled trials, prospective cohort studies, and case-controlled studies published from January 2005 to 28 August 2020. Two independent reviewers conducted the study appraisal, data extraction, and quality assessment of the studies. Results A total of 60 full-text studies were included in the final systematic review analysis. Increasing infarct core volume is associated with reduced odds of achieving functional independence (modified Rankin score 0–2) at 90 days and is correlated with the final infarct volume when reperfusion is achieved. Conclusion CTP has value in assessing tissue perfusion status in the hyperacute stroke setting and the long-term clinical prognosis of patients with AIS receiving reperfusion therapy. However, the prognostic use of CTP requires optimization and further validation.

scholarly journals Computed Tomography Perfusion Data for Acute Ischemic Stroke Evaluation Using Rapid Software

2020 ◽  
Vol 44 (1) ◽  
pp. 75-77 ◽  
Author(s):  
Frans Kauw ◽  
Jeremy J. Heit ◽  
Blake W. Martin ◽  
Fasco van Ommen ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Perfusion

scholarly journals Computed Tomography Perfusion–Based Machine Learning Model Better Predicts Follow-Up Infarction in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 223-231
Author(s):  
Hulin Kuang ◽  
Wu Qiu ◽  
Anna M. Boers ◽  
Scott Brown ◽  
Keith Muir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Interquartile Range ◽  
Time Dependent ◽  
Computed Tomography Perfusion

Background and Purpose: Prediction of infarct extent among patients with acute ischemic stroke using computed tomography perfusion is defined by predefined discrete computed tomography perfusion thresholds. Our objective is to develop a threshold-free computed tomography perfusion–based machine learning (ML) model to predict follow-up infarct in patients with acute ischemic stroke. Methods: Sixty-eight patients from the PRoveIT study (Measuring Collaterals With Multi-Phase CT Angiography in Patients With Ischemic Stroke) were used to derive a ML model using random forest to predict follow-up infarction voxel by voxel, and 137 patients from the HERMES study (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) were used to test the derived ML model. Average map, T max , cerebral blood flow, cerebral blood volume, and time variables including stroke onset-to-imaging and imaging-to-reperfusion time, were used as features to train the ML model. Spatial and volumetric agreement between the ML model predicted follow-up infarct and actual follow-up infarct were assessed. Relative cerebral blood flow <0.3 threshold using RAPID software and time-dependent T max thresholds were compared with the ML model. Results: In the test cohort (137 patients), median follow-up infarct volume predicted by the ML model was 30.9 mL (interquartile range, 16.4–54.3 mL), compared with a median 29.6 mL (interquartile range, 11.1–70.9 mL) of actual follow-up infarct volume. The Pearson correlation coefficient between 2 measurements was 0.80 (95% CI, 0.74–0.86, P <0.001) while the volumetric difference was −3.2 mL (interquartile range, −16.7 to 6.1 mL). Volumetric difference with the ML model was smaller versus the relative cerebral blood flow <0.3 threshold and the time-dependent T max threshold ( P <0.001). Conclusions: A ML using computed tomography perfusion data and time estimates follow-up infarction in patients with acute ischemic stroke better than current methods.

scholarly journals Noncontrast Computed Tomography e-Stroke Infarct Volume Is Similar to RAPID Computed Tomography Perfusion in Estimating Postreperfusion Infarct Volumes

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 634-641 ◽  
Author(s):  
Mehdi Bouslama ◽  
Krishnan Ravindran ◽  
George Harston ◽  
Gabriel M. Rodrigues ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Noncontrast Computed Tomography ◽  
Core Volume

Background and Purpose: The e-Stroke Suite software (Brainomix, Oxford, United Kingdom) is a tool designed for the automated quantification of The Alberta Stroke Program Early CT Score and ischemic core volumes on noncontrast computed tomography (NCCT). We sought to compare the prediction of postreperfusion infarct volumes and the clinical outcomes across NCCT e-Stroke software versus RAPID (IschemaView, Menlo Park, CA) computed tomography perfusion measurements. Methods: All consecutive patients with anterior circulation large vessel occlusion stroke presenting at a tertiary care center between September 2010 and November 2018 who had available baseline infarct volumes on both NCCT e-Stroke Suite software and RAPID CTP as well as final infarct volume (FIV) measurements and achieved complete reperfusion (modified Thrombolysis in Cerebral Infarction scale 2c-3) post-thrombectomy were included. The associations between estimated baseline ischemic core volumes and FIV as well as 90-day functional outcomes were assessed. Results: Four hundred seventy-nine patients met inclusion criteria. Median age was 64 years (55–75), median e-Stroke and computed tomography perfusion ischemic core volumes were 38.4 (21.8–58) and 5 (0–17.7) mL, respectively, whereas median FIV was 22.2 (9.1–56.2) mL. The correlation between e-Stroke and CTP ischemic core volumes was moderate (R=0.44; P <0.001). Similarly, moderate correlations were observed between e-Stroke software ischemic core and FIV (R=0.52; P <0.001) and CTP core and FIV (R=0.43; P <0.001). Subgroup analysis showed that e-Stroke software and CTP performance was similar in the early and late (>6 hours) treatment windows. Multivariate analysis showed that both e-Stroke software NCCT baseline ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) and RAPID CTP ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) were independently and comparably associated with good outcome (modified Rankin Scale score of 0–2) at 90 days. Conclusions: NCCT e-Stroke Suite software performed similarly to RAPID CTP in assessing postreperfusion FIV and functional outcomes for both early- and late-presenting patients. NCCT e-Stroke volumes seems to represent a viable alternative in centers where access to advanced imaging is limited. Moreover, the future development of fusion maps of NCCT and CTP ischemic core estimates may improve upon the current performance of these tools as applied in isolation.

Enhancing performance of a computed tomography perfusion software for improved prediction of final infarct volume in acute ischemic stroke patients

2021 ◽  
pp. 197140092098866
Author(s):  
Ryan A Rava ◽  
Kenneth V Snyder ◽  
Maxim Mokin ◽  
Muhammad Waqas ◽  
Alexander R Podgorsak ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Conservative Treatment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Correlation Coefficients ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Computed Tomography Perfusion

Computed tomography perfusion (CTP) is crucial for acute ischemic stroke (AIS) patient diagnosis. To improve infarct prediction, enhanced image processing and automated parameter selection have been implemented in Vital Images’ new CTP+ software. We compared CTP+ with its previous version, commercially available software (RAPID and Sphere), and follow-up diffusion-weighted imaging (DWI). Data from 191 AIS patients between March 2019 and January 2020 was retrospectively collected and allocated into endovascular intervention ( n = 81) and conservative treatment ( n = 110) cohorts. Intervention patients were treated for large vessel occlusion, underwent mechanical thrombectomy, and achieved successful reperfusion of thrombolysis in cerebral infarction 2b/2c/3. Conservative treatment patients suffered large or small vessel occlusion and did not receive intravenous thrombolysis or mechanical thrombectomy. Infarct and penumbra were assessed using intervention and conservative treatment patients, respectively. Infarct and penumbra volumes were segmented from CTP+ and compared with 24-h DWI along with RAPID, Sphere, and Vitrea. Mean infarct differences (95% confidence intervals) and Spearman correlation coefficients (SCCs) between DWI and each CTP software product for intervention patients are: CTP+  = (5.8 ± 5.9 ml, 0.62), RAPID = (10.0  ± 5.2 ml, 0.73), Sphere = (3.0 ± 6.0 ml, 0.56), Vitrea = (7.2 ± 4.9 ml, 0.66). For conservative treatment patients, mean infarct differences and SCCs are: CTP+ = (–8.0 ± 5.4 ml, 0.64), RAPID = (–25.6 ± 11.5 ml, 0.60), Sphere = (–25.6 ± 8.0 ml, 0.66), Vitrea = (1.3 ± 4.0 ml, 0.72). CTP+ performed similarly to RAPID and Sphere in addition to its semi-automated predecessor, Vitrea, when assessing intervention patient infarct volumes. For conservative treatment patients, CTP+ outperformed RAPID and Sphere in assessing penumbra. Semi-automated Vitrea remains the most accurate in assessing penumbra, but CTP+ provides an improved workflow from its predecessor.

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