Abstract 3048: Real-World Clinical Use of CT Perfusion for Diagnosis and Prediction of Lesion Growth in Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Branko N Huisa ◽  
William P Neil ◽  
Nhu T Bruce ◽  
Marcel Maya ◽  
Benedict Pereira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Medical Center ◽  
Brain Mri ◽  
Academic Medical Center ◽  
Acute Ischemia ◽  
Perfusion Maps

Background: Diffusion-weighted imaging (DWI) detects acute ischemia with a high sensitivity. In research centers, qualitative CT perfusion (CTP) mapping correlates well with DWI and may accurately differentiate the infarct core from ischemic penumbra. The value of the CTP in real-world clinical practice, however, has not been fully established. We investigated the yield of CTP - derived cerebral blood volume (CBV) and mean transient time (MTT) for the detection of cerebral ischemia in a sample of acute ischemic stroke (AIS) patients. Methods: In a large metropolitan academic medical center that is a certified Primary Stroke Center (PSC) we retrospectively studied 162 patients who presented between January 2008 and July 2010 with symptoms suggestive of AIS. All patients had an initial Code Brain protocol including non-contrast head CT, CTP, and CTA. As clinically indicated, some patients underwent follow up brain MRI within 48 hours. Acute perfusion maps were derived in real time by a trained operator. From the obtained images CBV, MTT and DWI lesion volumes were manually traced using planimetry (ImageJ v1.42) by two stroke neurologists blinded to clinical information. Volumes were calculated using the Cavaleri theorem. Sensitivity, specificity and statistical analysis were calculated using Graph Pad 5.0. Results: Of 162 patients with acute stroke-like symptoms, 73 had DWI lesions. The sensitivity and specificity to detect abnormal DWI signals were 23% and 100%, for CBV; and 43.8% and 98.9% for MTT. For DWI lesions ≥5ml the yield was 59.3% for CVB and 77.8% for MTT. For lesions ≥10ml the yield was 68.4% for CBV and 89.5% for MTT. In patients with NIHSS ≥5, CBV predicted abnormal DWI in 22.6% and MTT in 35.5%. In patients with NIHSS ≥10, CBV and MTT, both had a yield of 50.0%. A CBV - MTT mismatch of >25% predicted MRI lesion extension in 81.25% of the cases. There were small but significant correlations for DWI versus CBV lesion volumes ( r 2 0.32, P= 0.0001), and for DWI versus MTT lesion volumes ( r 2 0.29, P <0.0001). Correlation between DWI and perfusion maps for MCA territory infarcts were CBV ( r 2 0.3, P <0.0001) and MTT ( r 2 0.45, P <0.0001). Conclusions: In real-world deployment during a Code Brain protocol in a busy PSC, acute imaging with CTP did not predict DWI lesions on brain MRI with sufficient accuracy. In patients with large lesions the predictive value was better.

Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy

2017 ◽  
Vol 10 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Katsuharu Kameda ◽  
Junji Uno ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Characteristic Curve ◽  
Mean Transit Time ◽  
Area Under The Curve ◽  
Ischemic Penumbra ◽  
Optimal Thresholds

Background and purposeOptimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT).MethodsA total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel. Optimal thresholds were calculated by performing receiver operating characteristic curve analysis in 47 patients who achieved Thrombolysis In Cerebral Infarction (TICI) grade 3 recanalization. The risk of HT after MT was evaluated in 101 patients who achieved TICI grade 2b–3 recanalization.ResultsAbsolute CTP parameters for distinguishing ischemic penumbra from ischemic core were as follows: aCBF, 27.8 mL/100 g/min (area under the curve 0.82); aCBV, 2.1 mL/100 g (0.75); and aMTT, 7.30 s (0.70). Relative CTP parameters were as follows: rCBF, 0.62 (0.81); rCBV, 0.83 (0.87); and rMTT, 1.61 (0.73). CBF was significantly lower in areas of HT than in areas of infarction (aCBF, p<0.01; rCBF, p<0.001).ConclusionsCTP may be able to predict treatable ischemic penumbra and the risk of HT after MT in patients with AIS.

scholarly journals Accuracy of Brain MRI Interpretation of Emergency Medicine Specialists versus Radiologist and Neurologist in Suspected Acute Ischemic Stroke Patients; a Diagnostic Accuracy Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Atefeh Abdollahi ◽  
Sepideh Aarabi ◽  
Arash Safaie ◽  
Abdorreza Naser Moghadasi ◽  
Mohammad Sadegh Vahedi ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Gold Standard ◽  
Medical Center ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Diagnostic Accuracy Study ◽  
Accuracy Study

Background: Despite numerous brain magnetic resonance imaging (MRI) utilization in the emergency department (ED), certainly, imaging alone is not enough, and it is necessary to have a correct interpretation by a physician who has sufficient skills in this regard. Objectives: Here, we decided to investigate the accuracy of interpreting brain MRI of suspected acute ischemic stroke (AIS) patients conducted by emergency medicine physicians (EMPs) in comparison with a radiologist and a neurologist. Methods: This diagnostic accuracy study was conducted from April to November 2019 in Tehran, Iran. All attending EMPs of one major educational, medical center, a radiologist, and a neurologist also participated. A set of brain MRI stereotypes related to patients suspected of having a AIS was randomly selected. By reviewing the brain MRI interpretation of EMPs, once in comparison with the radiologist and once in comparison with the neurologist, misinterpretations (presence or absence of findings compatible with the diagnosis of AIS) were extracted. Results: Brain MRI stereotypes of 287 suspected AIS patients were interpreted of these patients, 160 cases (55.7%) were male. The mean age of the study patients was 65.0 ± 14.1 (range of 18 to 98) years. The value of the agreement for diagnosis between EMPs and neurologists was 0.684 (95% CI: 0.580 to 0.787). Considering the neurologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 0.85% (95% CI: 79.3 to 89.6). The agreement value for diagnosis between EMPs and radiologist was 0.673 (95% CI: 0.553 to 0.794). Considering the radiologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 86.3% (95% CI: 79.8 to 91.3). The agreement value for diagnosis in these two groups was 0.752 (95% CI: 0.627 to 0.877). Conclusions: The findings of the current study revealed that the accuracy of brain MRI interpretation performed by the EMPs, compared with both neurologist and radiologist was proper.

scholarly journals Neural Network-derived perfusion maps: a Model-free approach to computed tomography perfusion in patients with acute ischemic stroke

2021 ◽  
Author(s):  
Umberto A. Gava ◽  
Federico D’Agata ◽  
Enzo Tartaglione ◽  
Marco Grangetto ◽  
Francesca Bertolino ◽  
...  
Keyword(s):  
Neural Network ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
State Of The Art ◽  
Ct Perfusion ◽  
Pearson Correlation ◽  
Ground Truth ◽  
Infarct Core ◽  
Model Free ◽  
Perfusion Maps

AbstractPurposeIn this study we investigate whether a Convolutional Neural Network (CNN) can generate clinically relevant parametric maps from CT perfusion data in a clinical setting of patients with acute ischemic stroke.MethodsTraining of the CNN was done on a subset of 100 perfusion data, while 15 samples were used as validation. All the data used for the training/validation of the network and to generate ground truth (GT) maps, using a state-of-the-art deconvolution-algorithm, were previously pre-processed using a standard pipeline. Validation was carried out through manual segmentation of infarct core and penumbra on both CNN-derived maps and GT maps. Concordance among segmented lesions was assessed using the Dice and the Pearson correlation coefficients across lesion volumes.ResultsMean Dice scores from two different raters and the GT maps were > 0.70 (good-matching). Inter-rater concordance was also high and strong correlation was found between lesion volumes of CNN maps and GT maps (0.99, 0.98).ConclusionOur CNN-based approach generated clinically relevant perfusion maps that are comparable to state-of-the-art perfusion analysis methods based on deconvolution of the data. Moreover, the proposed technique requires less information to estimate the ischemic core and thus might allow the development of novel perfusion protocols with lower radiation dose.

scholarly journals E-048 Real world availability and utilization of ct perfusion in acute ischemic stroke

2019 ◽  
Author(s):  
A Czap ◽  
S Lee ◽  
V Lopez-Rivera ◽  
J Grotta ◽  
P Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Ct Perfusion

Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke

2016 ◽  
Vol 30 (6) ◽  
pp. 606-611 ◽  
Author(s):  
Elise L. Metts ◽  
Abby M. Bailey ◽  
Kyle A. Weant ◽  
Stephanie B. Justice
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Sample ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Turnaround Time ◽  
Ct Scanner ◽  
Physician Consultation

Background: Tissue plasminogen activator (tPA) is the only pharmacotherapy shown to improve outcomes in acute ischemic stroke. The American Heart Association (AHA) recommends a door-to-needle (DTN) time of <60 minutes in at least 50% of patients presenting with acute ischemic stroke. Objective: The purpose of this study was to analyze the possible barriers that may delay tPA administration within the emergency department (ED) of an academic medical center. Methods: A retrospective chart review was conducted from February 2011 to October 2013. Patients were included if they were admitted through the ED with a diagnosis of acute ischemic stroke and received tPA. Results: Of the 130 patients who met inclusion criteria, 43.1% received tPA in ≤60 minutes. Several factors were identified to be significantly different in those with a DTN time of >60 minutes—time to ED physician consultation, neurologist arrival, blood sample acquisition, and result time ( P < .05 for all comparisons). Correlation analysis demonstrated several independent variables associated with DTN time of ≤60 minutes—time from admission to ED physician consultation, receipt of computed tomography (CT) scan, blood sample acquisition, laboratory results, and neurology service arrival ( P < .05 for all comparisons). Conclusion: The findings from this study highlight the importance of prompt physician evaluation, direct transfer to the CT scanner, and a quick turnaround time on laboratory values. The development of protocols to ensure the rapid receipt of tPA therapy should focus on limiting any potential delay these steps may cause.

Whole-Brain CT Perfusion Measurement of Perfused Cerebral Blood Volume in Acute Ischemic Stroke: Probability Curve for Regional Infarction

Radiology ◽  
2003 ◽  
Vol 227 (3) ◽  
pp. 725-730 ◽  
Author(s):  
George J. Hunter ◽  
Heli M. Silvennoinen ◽  
Leena M. Hamberg ◽  
Walter J. Koroshetz ◽  
Ferdinando S. Buonanno ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Whole Brain ◽  
Probability Curve ◽  
Brain Ct ◽  
Perfusion Measurement

Abstract TP245: Prediction of Hemorrhagic Transformation in Patients With Acute Ischaemic Stroke and Atrial Fibrillation With Ct Perfusion Aspects Scores

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Qiaoshu Wang ◽  
Yanyan Cao ◽  
Yongbo Zhao ◽  
Louis Caplan
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Roc Analysis ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Operating Characteristics ◽  
Middle Cerebral Artery Infarction

Background and Purpose: Hemorrhage transformation (HT) is common in patients with acute cerebral infarction caused by atrial fibrillation. The prediction of HT is crucial after acute stroke, especially for the patients received vessel recanalization therapy. The Alberta Stroke program early CT score (ASPECTS) is used to estimate early ischemic changes within the MCA territory in the acute stroke setting. Several studies indicated that CT perfusion (CTP) and MR diffusion weighted imaging (DWI) ASPECTS scores was useful to quantify the degree of ischemic brain tissue. Hereby we did the study to explore the association of CT perfusion ASPECTS scores with HT in patients with acute ischemic stroke and atrial fibrillation. Methods: This was a single center retrospective study. All patients with middle cerebral artery infarction and atrial fibrillation from September 2008 to September 2013 were included. MR imaging including DWI and gradient echo sequence (GRE), and CTP were required to identify the HT and determine the scores of CTP- ASPECTS. Demographic and clinical characteristics of the HT positive and negative groups were explored. Results: Fifty-four patients were analyzed, among them twenty-four patients (44%) developed HT. According to logistic regression analysis, mean transit time (MTT), cerebral blood volume (CBV) and DWI-ASPECTS scores were associated with HT ( p = 0.035, 0.044, and 0.020 respectively). The following receiver operating characteristics (ROC) analysis revealed area under the curve of MTT, CBV, CBF and DWI were 0.588, 0.737, 0.687, and 0.841 respectively. CBV-ASPECTS score was found to have medium prediction value of HT among all CTP-ASPECTS parameters. ROC analysis also indicated that CBV-ASPECTS score < 7 was the optimal threshold. Conclusions: CTP-ASPECTS was useful to predict the HT of acute ischemic stroke caused by atrial fibrillation and CBV-ASPECTS score < 7 was the preferable parameter.

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