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Article: Automated CT perfusion imaging versus non-contrast CT for ischemic core assessment in large vessel occlusion

TitleAutomated CT perfusion imaging versus non-contrast CT for ischemic core assessment in large vessel occlusion
Authors
KeywordsLarge vessel occlusion
Ischemic stroke
RAPID
Stroke imaging
Endovascular thrombectomy
Issue Date2020
PublisherSpringer Medizin. The Journal's web site is located at http://www.springer.com/medicine/radiology/journal/62
Citation
Clinical Neuroradiology, 2020, v. 30, p. 109-114 How to Cite?
AbstractPurpose: 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 (rs: 0.62; p < 0.001), but poor correlation between RAPID-CTP-ASPECTS and RAPID-CTP ischemic core volume with 24h NCCT-ASPECTS (rs: 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.
Persistent Identifierhttp://hdl.handle.net/10722/266049
ISSN
2020 Impact Factor: 3.649
2020 SCImago Journal Rankings: 0.792
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorTsang, COA-
dc.contributor.authorLenck, S-
dc.contributor.authorHilditch, C-
dc.contributor.authorNicholson, P-
dc.contributor.authorBrinjikji, W-
dc.contributor.authorKrings, T-
dc.contributor.authorPereira, VM-
dc.contributor.authorSilver, FL-
dc.contributor.authorSchaafsma, JD-
dc.date.accessioned2018-12-17T02:16:38Z-
dc.date.available2018-12-17T02:16:38Z-
dc.date.issued2020-
dc.identifier.citationClinical Neuroradiology, 2020, v. 30, p. 109-114-
dc.identifier.issn1869-1439-
dc.identifier.urihttp://hdl.handle.net/10722/266049-
dc.description.abstractPurpose: 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 (rs: 0.62; p < 0.001), but poor correlation between RAPID-CTP-ASPECTS and RAPID-CTP ischemic core volume with 24h NCCT-ASPECTS (rs: 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.-
dc.languageeng-
dc.publisherSpringer Medizin. The Journal's web site is located at http://www.springer.com/medicine/radiology/journal/62-
dc.relation.ispartofClinical Neuroradiology-
dc.rightsThe final publication is available at Springer via http://dx.doi.org/10.1007/s00062-018-0745-6-
dc.subjectLarge vessel occlusion-
dc.subjectIschemic stroke-
dc.subjectRAPID-
dc.subjectStroke imaging-
dc.subjectEndovascular thrombectomy-
dc.titleAutomated CT perfusion imaging versus non-contrast CT for ischemic core assessment in large vessel occlusion-
dc.typeArticle-
dc.identifier.emailTsang, COA: acotsang@hku.hk-
dc.identifier.authorityTsang, COA=rp01519-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00062-018-0745-6-
dc.identifier.pmid30470847-
dc.identifier.scopuseid_2-s2.0-85057076677-
dc.identifier.hkuros296372-
dc.identifier.volume30-
dc.identifier.spage109-
dc.identifier.epage114-
dc.identifier.isiWOS:000520705800016-
dc.publisher.placeGermany-
dc.identifier.issnl1869-1439-

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