PT  - JOURNAL ARTICLE
AU  - Kamalian, Shervin
AU  - Kamalian, Shahmir
AU  - Konstas, A.A.
AU  - Maas, M.B.
AU  - Payabvash, S.
AU  - Pomerantz, S.R.
AU  - Schaefer, P.W.
AU  - Furie, K.L.
AU  - González, R.G.
AU  - Lev, M.H.
TI  - CT Perfusion Mean Transit Time Maps Optimally Distinguish Benign Oligemia from True “At-Risk” Ischemic Penumbra, but Thresholds Vary by Postprocessing Technique
AID  - 10.3174/ajnr.A2809
DP  - 2012 Mar 01
TA  - American Journal of Neuroradiology
PG  - 545--549
VI  - 33
IP  - 3
4099  - http://www.ajnr.org/content/33/3/545.short
4100  - http://www.ajnr.org/content/33/3/545.full
SO  - Am. J. Neuroradiol.2012 Mar 01; 33
AB  - BACKGROUND AND PURPOSE: Various CTP parameters have been used to identify ischemic penumbra. The purpose of this study was to determine the optimal CTP parameter and threshold to distinguish true “at-risk” penumbra from benign oligemia in acute stroke patients without reperfusion. MATERIALS AND METHODS: Consecutive stroke patients were screened and 23 met the following criteria: 1) admission scanning within 9 hours of onset, 2) CTA confirmation of large vessel occlusion, 3) no late clinical or radiographic evidence of reperfusion, 4) no thrombolytic therapy, 5) DWI imaging within 3 hours of CTP, and 6) either CT or MR follow-up imaging. CTP was postprocessed with commercial software packages, using standard and delay-corrected deconvolution algorithms. Relative cerebral blood flow, volume, and mean transit time (rCBF, rCBV and rMTT) values were obtained by normalization to the uninvolved hemisphere. The admission DWI and final infarct were transposed onto the CTP maps and receiver operating characteristic curve analysis was performed to determine optimal thresholds for each perfusion parameter in defining penumbra destined to infarct. RESULTS: Relative and absolute MTT identified penumbra destined to infarct more accurately than CBF or CBV*CBF (P < .01). Absolute and relative MTT thresholds for defining penumbra were 12s and 249% for the standard and 13.5s and 150% for the delay-corrected algorithms, respectively. CONCLUSIONS: Appropriately thresholded absolute and relative MTT-CTP maps optimally distinguish “at-risk” penumbra from benign oligemia in acute stroke patients with large-vessel occlusion and no reperfusion. The precise threshold values may vary, however, depending on the postprocessing technique used for CTP map construction. aabsolute measuresACAanterior cerebral arteryAUCarea under the curveBGbasal gangliaGMgray matterrrelative (normalized) measuresROCreceiver operating characteristic