Abstract
BACKGROUND AND PURPOSE: Brain CTP is used to estimate infarct and penumbra volumes to determine endovascular treatment eligibility for patients with acute ischemic stroke. We aimed to assess the accuracy of a Bayesian CTP algorithm in determining penumbra and final infarct volumes.
MATERIALS AND METHODS: Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. Vitrea settings used different combinations of perfusion maps (MTT, TTP, CBV, CBF, delay time) for infarct and penumbra quantification. Patients with and without interventions were included for assessment of predicted infarct and penumbra volumes, respectively.
RESULTS: RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions ([Spearman correlation coefficient, mean infarct difference] default versus FLAIR: [0.77, 4.1 mL], default versus DWI: [0.72, 4.7 mL], RAPID versus FLAIR: [0.75, 7.5 mL], RAPID versus DWI: [0.75, 6.9 mL]). Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively (default versus FLAIR: [0.76, –0.4 mL], default versus DWI: [0.71, –2.6 mL], RAPID versus FLAIR: [0.68, −49.3 mL], RAPID versus DWI: [0.65, –51.5 mL]).
CONCLUSIONS: Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.
ABBREVIATIONS:
- AIS
- acute ischemic stroke
- FIV
- final infarct volume
- MAE
- mean absolute error
- Tmax
- time until the residue function reaches its peak
Footnotes
This research was funded by Canon Medical Systems USA.
Disclosures: Ryan A. Rava—RELATED: Grant: James H. Cummings Foundation Inc*; Other: Canon Medical Systems Inc. Maxim Mokin—UNRELATED: Consultancy: Medtronic, Canon Medical Systems Inc; Stock/Stock Options: Serenity Medical, VICIS. Ariana B. Allman—RELATED: Grant: James H. Cummings Foundation Inc*; Other: Canon Medical Systems Inc.* Mohammad Mahdi Shiraz Bhurwani—RELATED: Grant: James H. Cummings Foundation Inc*; Other: Canon Medical Systems Inc.* Yiemeng Hoi—UNRELATED: Employment: Canon Medical Systems Inc. Adnan H. Siddiqui—UNRELATED: Consultancy: Amnis Therapeutics, Boston Scientific, Canon Medical Systems Inc, Cerebrotech Medical Systems, Cerenovus, Corindus Inc, ENDOSTREAM MEDICAL LTD, Guidepoint Global, Imperative Care, Integra Medical Services, Medtronic, MicroVention, Northwest University Data and Safety Monitoring Board Chair for the HEAT Trial, Penumbra, Q’Apel Medical, Rapid Medical, Rebound Therapeutics Corp, Serenity Medical, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, W.L. Gore & Associates; Stock/Stock Options: Amnis Therapeutics, Blinktbi, Buffalo Technology Partners LLC, Cardinal Consultants LLC, Cerebrotech Medical Systems, Cognition Medical, ENDOSTREAM MEDICAL LTD, Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc, Q’Apel Medical, Rebound Therapeutics Corp, Rist Neurovascular, Serenity Medical, Silk Road Medical, Spinnaker Medical Consultants, StimMed, Synchron, Three Rivers Medical, Viseon Spine; Other: National Principal Investigator/Steering Committees: Cerenovus NAPA trial and ARISE II trial; Medtronic SWIFT PRIME and SWIFT DIRECT trials; MicroVention FRED trial and CONFIDENCE study; MUSC POSITIVE trial; Penumbra 3D Separator trial, COMPASS trial, INVEST trial. Jason M. Davies—RELATED: Grant: James H. Cummings Foundation Inc*; UNRELATED: Consultancy: Medtronic; Grants/Grants Pending: National Institutes of Health–National Institute of Neurological Disorders and Stroke; Stock/Stock Options: Rist Neurovascular, Cerebrotech Medical Systems. Elad I. Levy—UNRELATED: Board Membership: Stryker, NeXtGen Biologics, MedX, Cognition Medical, ENDOSTREAM MEDICAL LTD*; Consultancy: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound Therapeutics, StimMed*; Stock/Stock Options: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics Corp, StimMed, Three Rivers Medical*; Other: Medtronic, Comments: honorarium.* Ciprian N. Ionita—RELATED: Grant: Canon Medical Systems Inc, National Institutes of Health*; UNRELATED: Grants/Grants Pending: National Institutes of Health, James H. Cummings Foundation Inc.* Jillian L. Senko—RELATED: Grant: James H. Cummings Foundation Inc*; Other: Canon Medical Systems Inc.* *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology