Abstract
BACKGROUND AND PURPOSE: Infarct core volume measurement using CTP (CT perfusion) is a mainstay paradigm for stroke treatment decision-making. Yet, there are several downfalls with cine CTP technology that can be overcome by adopting the simple perfusion reconstruction algorithm (SPIRAL) derived from multiphase CTA. We compare SPIRAL with CTP parameters for the prediction of 24-hour infarction.
MATERIALS AND METHODS: Seventy-two patients had admission NCCT, multiphase CTA, CTP, and 24-hour DWI. All patients had successful/quality reperfusion. Patient-level and cohort-level receiver operator characteristic curves were generated to determine accuracy. A 10-fold cross-validation was performed on the cohort-level data. Infarct core volume was compared for SPIRAL, CTP–time-to-maximum, and final DWI by Bland-Altman analysis.
RESULTS: When we compared the accuracy in patients with early and late reperfusion for cortical GM and WM, there was no significant difference at the patient level (0.83 versus 0.84, respectively), cohort level (0.82 versus 0.81, respectively), or the cross-validation (0.77 versus 0.74, respectively). In the patient-level receiver operating characteristic analysis, the SPIRAL map had a slightly higher, though nonsignificant (P < .05), average receiver operating characteristic area under the curve (cortical GM/WM, r = 0.82; basal ganglia = 0.79, respectively) than both the CTP–time-to-maximum (cortical GM/WM = 0.82; basal ganglia = 0.78, respectively) and CTP-CBF (cortical GM/WM = 0.74; basal ganglia = 0.78, respectively) parameter maps. The same relationship was observed at the cohort level. The Bland-Altman plot limits of agreement for SPIRAL and time-to-maximum infarct volume were similar compared with 24-hour DWI.
CONCLUSIONS: We have shown that perfusion maps generated from a temporally sampled helical CTA are an accurate surrogate for infarct core.
ABBREVIATIONS:
- AUC
- area under the curve
- EVT
- endovascular therapy
- mCTA
- multiphase CTA
- ROC
- receiver operating characteristic
- SPIRAL
- simple perfusion reconstruction algorithm
- Tmax
- time-to-maximum
Footnotes
This work was supported by the Heart and Stroke Foundation of Canada by a grant-in-aid for the REPERFUSE study.
Disclosures: Commor McDougall—UNRELATED: Comments: stock ownership in Andromeda Medical Imaging Inc. Andrew M. Demchuk—UNRELATED: Employment: University of Calgary; Patents (Planned, Pending or Issued): Circle NVI, Comments: imaging software; Stock/Stock Options: Circle NVI, Comments: imaging software. Nils Daniel Forkert—UNRELATED: Grants/Grants Pending: Natural Sciences and Engineering Research Council of Canada, Canada Research Chair.* Michael D. Hill—UNRELATED: Board Membership: CNS Foundation, Circle NVI, Comments: unpaid, stock ownership in Circle NVI; Consultancy: NoNo, Comments: unpaid; Grants/Grants Pending: Stryker, Medtronic, NoNo, Boehringer Ingelheim, Comments: grants for clinical trials*; Patents (Planned, Pending or Issued): US Patent office No. 62/086,077; Stock/Stock Options: Circle NVI; Other: Sun Pharmaceutical Industries, Comments: adjudicator for outcomes in clinical trials, safety monitor, paid position. Christopher d’Esterre—UNRELATED: Comments: stock ownership in Andromeda Medical Imaging Inc. Philip A. Barber—RELATED: Grant: Canadian Institutes of Health Research grant*; Consulting Fee or Honorarium: Ablynx.* UNRELATED: Comments: stock ownership in Andromeda Medical Imaging Inc. *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology
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