Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke

2022 ◽  
Author(s):  
Yue Chu ◽  
Guang-Chen Shen ◽  
Gao Ma ◽  
Xiao-Quan Xu ◽  
Shan-Shan Lu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion

scholarly journals Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP)

2019 ◽  
Vol 8 (2-6) ◽  
pp. 116-122
Author(s):  
Ameer E. Hassan ◽  
Hafsah Shamim ◽  
Haralabos Zacharatos ◽  
Saqib A. Chaudhry ◽  
Christina Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Ct Perfusion ◽  
Treatment Decision ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Contrast Ct

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment. Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging. Methods: Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment. All patients had non-contrast CT, CT angiography, and CTP. The neuro-interventionalist was blinded to the results of the CTP and based the treatment decision using the Alberta Stroke Program Early CT score (ASPECTS). Baseline demographics, co-morbidities, and baseline NIHSS scores were collected. Outcomes were modified Rankin scale (mRS) score at discharge and in-hospital mortality. Good outcomes were defined as a mRS score of 0–2. Results: 283 AIS patients were screened for the trial, and 119 were enrolled. The remaining patients were excluded for: posterior circulation stroke, no CTP performed, could not obtain consent, and NIHSS score < 7. Mean ­NIHSS score at admission was 16.8 ± 3, and mean ASPECTS was 8.4 ± 1.4. There was no statistically significant correlation with CTP penumbra and good outcomes: 50 versus 47.8% with no penumbra present (p = 0.85). In patients without evidence of CTP penumbra, there was 22.5% mortality compared to 22.1% mortality in patients with a CTP penumbra. If ASPECTS ≥7, 64.6% had good outcome versus 13.3% if ASPECTS < 7 (p < 0.001). Patients with an ASPECTS ≥7 had 10% mortality versus 51.4% in patients with an ASPECTS < 7 (p < 0.001). Conclusions: CTP penumbra did not identify patients who would benefit from endovascular treatment when patients were selected with non-contrast CT ASPECTS ≥7. There is no correlation of CTP penumbra with good outcomes or mortality. Larger prospective trials are warranted to justify the use of CTP within 6 h of symptom onset.

scholarly journals Multimodal Computed Tomography in Acute Ischemic Stroke

US Neurology ◽  
2010 ◽  
Vol 06 (01) ◽  
pp. 50 ◽  
Author(s):  
Sachin Rastogi ◽  
David S Liebeskind ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Vascular Occlusion ◽  
Vascular Pathology ◽  
Stroke Patients ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram

Stroke is the third leading cause of death in the US, affecting 795,000 individuals annually. Currently, only a small percentage of acute stroke patients receive thrombolytic treatment. A significant limitation is the current use of strict time criteria in the decision to treat. As there are significant interindividual variations in response to an acute vascular occlusion, the goal of modern imaging such as multimodal computed tomography (CT) is to rapidly identify acute ischemic stroke patients and determine which patients are likely to benefit from treatment based on tissue perfusion status rather than time of presentation alone. Multimodal CT consists of a non-contrast head CT, CT angiogram (CTA) of the head and neck, and CT perfusion (CTP). The non-contrast head CT allows rapid triage of a patient with hemorrhagic versus ischemic stroke. The CTA allows identification of the site of vascular pathology with similar quality to digital subtraction angiography. The CTP scan allows for determination of the infarct core and surrounding ischemic penumbra, which remains at risk for infarction if perfusion is not restored. This allows the potential to prospectively treat only those patients likely to benefit from thrombolysis while protecting those patients unlikely to benefit from the risks associated with treatment.

scholarly journals Structured Reporting of Acute Ischemic Stroke – Consensus-Based Reporting Templates for Non-Contrast Cranial Computed Tomography, CT Angiography, and CT Perfusion

2021 ◽  
Author(s):  
Cornelia Brendle ◽  
Benjamin Bender ◽  
Nadja Selo ◽  
Sven Poli ◽  
Johannes Tünnerhoff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
German Society ◽  
Structured Reporting ◽  
Cranial Computed Tomography ◽  
Key Points ◽  
Reporting Templates

Purpose Structured reporting is an essential step in establishing standardized quality standards in diagnostic radiology. The German Society of Radiology and the German Society of Neuroradiology aim to provide templates for the structured reporting of different radiological examinations. Method The Information Technology working group of the German Society of Radiology developed structured templates for the radiological reporting of different indications in consensus with specialist support by experts. Results We present a template for the structured reporting of examinations of patients with acute ischemic stroke by non-contrast computed tomography, CT angiography, and CT perfusion. This template is provided on the website www.befundung.drg.de for free use. Conclusion Implementation of the structured template may increase quality and provide a minimum standard for radiological reports in patients with acute ischemic stroke. Key Points: Citation Format

Abstract WMP22: Multiparametric CT Perfusion to Determine the Collaterals Status in Patients With Acute Ischemic Stroke: A New Perfusion Index

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ahmed J Awad ◽  
Sayedhedayatollah E Tadayon ◽  
Daniel Wei ◽  
Reham R Haroun ◽  
Thomas J Oxley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Ct Perfusion ◽  
Multivariate Logistic Regression Analysis ◽  
Perfusion Index ◽  
Repeated Measure ◽  
Collateral Flow ◽  
Sensitivity Specificity

Introduction: Good collateral flow is an independent predictor of reperfusion that can be used to extend the treatment window in the new era of endovascular therapies for patients with acute ischemic stroke (AIS). Using a multiparametric approach, we aimed to identify perfusion parameter/s that can represent the extent of collaterals in comparison to CTA. Methods: AIS patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion were included. CT perfusion data were processed by Bayesian method to generate arterial tissue delay (ATD) maps at thresholds of 2 & 6 seconds. The volume of mild delayed perfusion (Vol-ATD >2sec ), moderate delayed (Vol-ATD 2-6sec ) and critical delayed perfusion (Vol-ATD >6sec ) in addition to corresponding rCBV and rCBF were calculated. Baseline CTA collaterals were scored using an established scoring scale1 and dichotomized to poor or good. The association of perfusion parameters and status of collaterals was assessed by repeated measure of analyses and receiver operating characteristic (ROC). Results: In 28 patients included, 16 had good collaterals on CTA. After controlling for age, sex, baseline NIHSS and type of treatment, multivariate logistic regression analysis identified rCBV (p<0.001) and ATD 2-6sec (p=0.003), but not rCBF, Vol-ATD > 2sec or Vol-ATD >6sec , as independent predictors of good collaterals. ROC analysis showed AUC of 0.88 (sensitivity/specificity: 75%/100%) for rCBV and AUC of 0.84 (sensitivity/specificity: 93%/67%) for Vol-ATD 2-6sec . We defined a perfusion collateral index (PCI) calculated from Vol-ATD 2-6sec x its rCBV, that remained an independent predictor of good collaterals with improved diagnostic accuracy over each measure alone resulting in nominal AUC of 1 (sensitivity/specificity: 100%/100%). Conclusions: Multiparametric CT perfusion can be used to assess the status of collaterals in patients with AIS. Perfusion collateral index (PCI) defined as Vol-ATD 2-6sec x rCBV is a new perfusion index with a nominal diagnostic accuracy of 100% compared to baseline CTA to predict status of collaterals in our small cohort. Our results need to be validated in a larger prospective cohort.

Total and regional ASPECT score for non-contrast CT, CT angiography, and CT perfusion: inter-rater agreement and its association with the final infarction in acute ischemic stroke patients

2021 ◽  
pp. 028418512110290
Author(s):  
Yue Chu ◽  
Gao Ma ◽  
Xiao-Quan Xu ◽  
Shan-Shan Lu ◽  
Yue-Zhou Cao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Caudate Nucleus ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Internal Capsule ◽  
Rater Agreement ◽  
Caudate Nuclei

Background Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a grading system to assess the extent and distribution of early ischemic changes. Purpose To assess inter-rater agreement for total and regional ASPECTS on non-contrast computed tomography (NCCT) images, CT angiography source images (CTA-SI), and CT-perfusion cerebral blood volume (CTP-CBV) maps, and their association with final infarction in patients with acute ischemic stroke (AIS). Material and Methods A total of 96 consecutive patients with AIS who underwent pre-treatment NCCT and CTP were retrospectively enrolled. CTA-SI was reconstructed using the raw data of CTP. Total and regional ASPECTS were assessed on baseline NCCT, CTA-SI, and CTP-CBV, and on follow-up NCCT or diffusion-weighted imaging. Follow-up ASPECTS served as the reference standard for final infarction. Results CTP-CBV demonstrated higher concordance for total ASPECTS (interclass correlation coefficient, 0.895 vs. 0.771 vs. 0.777) and regional ASPECTS in internal capsule, lentiform, caudate nuclei, M5 and M6, compared with NCCT and CTA-SI. CTP-CBV showed a trend of stronger correlation with final ASPECTS than NCCT and CTA-SI (0.717 vs. 0.711 vs. 0.565; P > 0.05). ASPECTS in the internal capsule (ρ, 0.756 vs. 0.556; P = 0.016) and caudate nucleus (ρ, 0.717 vs. 0.476; P = 0.010) on CTP-CBV were more strongly correlated with follow-up ASPECTS than NCCT. CTP-CBV showed higher accuracy for predicting final infarction in the internal capsule (92.5% vs. 90.3% and 87.1%; P > 1.000, P = 0.125, respectively) and caudate nucleus (87.1% vs. 79.6% and 77.4%; P = 0.453, P = 0.039, respectively) than CTA-SI and NCCT. Conclusion CTP-CBV ASPECTS might be more reliable for delineating early ischemic changes and predicting final infarction.

scholarly journals Diagnostic Accuracy of CT Perfusion Imaging for Detecting Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 35 (6) ◽  
pp. 493-501 ◽  
Author(s):  
J.M. Biesbroek ◽  
J.M. Niesten ◽  
J.W. Dankbaar ◽  
G.J. Biessels ◽  
B.K. Velthuis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Meta Analysis ◽  
Ct Perfusion Imaging

Predictive value of time-variant color-coded multiphase CT angiography (mCTA) regarding clinical outcome of acute ischemic stroke: in comparison with conventional mCTA and CT perfusion

2020 ◽  
pp. 028418512098177
Author(s):  
Yu Lin ◽  
Nannan Kang ◽  
Jianghe Kang ◽  
Shaomao Lv ◽  
Jinan Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Multivariate Logistic Regression Model ◽  
Infarct Core ◽  
Predictive Values ◽  
Significant Difference ◽  
Core Volume

Background Color-coded multiphase computed tomography angiography (mCTA) can provide time-variant blood flow information of collateral circulation for acute ischemic stroke (AIS). Purpose To compare the predictive values of color-coded mCTA, conventional mCTA, and CT perfusion (CTP) for the clinical outcomes of patients with AIS. Material and Methods Consecutive patients with anterior circulation AIS were retrospectively reviewed at our center. Baseline collateral scores of color-coded mCTA and conventional mCTA were assessed by a 6-point scale. The reliabilities between junior and senior observers were assessed by weighted Kappa coefficients. Receiver operating characteristic (ROC) curves and multivariate logistic regression model were applied to evaluate the predictive capabilities of color-coded mCTA and conventional mCTA scores, and CTP parameters (hypoperfusion and infarct core volume) for a favorable outcome of AIS. Results A total of 138 patients (including 70 cases of good outcomes) were included in our study. Patients with favorable prognoses were correlated with better collateral circulations on both color-coded and conventional mCTA, and smaller hypoperfusion and infarct core volume (all P < 0.05) on CTP. ROC curves revealed no significant difference between the predictive capability of color-coded and conventional mCTA ( P = 0.427). The predictive value of CTP parameters tended to be inferior to that of color-coded mCTA score (all P < 0.001). Both junior and senior observers had consistently excellent performances (κ = 0.89) when analyzing color-coded mCTA maps. Conclusion Color-coded mCTA provides prognostic information of patients with AIS equivalent to or better than that of conventional mCTA and CTP. Junior radiologists can reach high diagnostic accuracy when interpreting color-coded mCTA images.

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