Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke

被引：36

作者：

Geuskens, Ralph R. E. G. ^{[1
]}

Borst, Jordi ^{[2
]}

Lucas, Marit ^{[1
]}

Boers, A. M. Merel ^{[1
]}

Berkhemer, Olvert A. ^{[2
]}

Roos, Yvo B. W. E. M. ^{[3
]}

van Walderveen, Marianne A. A. ^{[4
]}

Jenniskens, Sjoerd F. M. ^{[5
]}

van Zwam, Wim H. ^{[6
]}

Dippel, Diederik W. J. ^{[7
]}

Majoie, Charles B. L. M. ^{[2
]}

Marquering, Henk A. ^{[1
,2
]}

机构：

[1] Univ Amsterdam, Acad Med Ctr, Dept Biomed Engn & Phys, NL-1105 AZ Amsterdam, Netherlands

[2] Univ Amsterdam, Acad Med Ctr, Dept Radiol, NL-1105 AZ Amsterdam, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Dept Neurol, NL-1105 AZ Amsterdam, Netherlands

[4] Leiden Univ, Med Ctr, Dept Radiol, Leiden, Netherlands

[5] Radboud Univ Nijmegen, Med Ctr, Dept Radiol, NL-6525 ED Nijmegen, Netherlands

[6] Maastricht Univ, Med Ctr, Dept Radiol, NL-6200 MD Maastricht, Netherlands

[7] Erasmus MC, Dept Neurol, Rotterdam, Netherlands

来源：

PLOS ONE | 2015年 / 10卷 / 11期

关键词：

COMPUTED-TOMOGRAPHY PERFUSION; CEREBRAL-BLOOD-FLOW; TECHNICAL IMPLEMENTATIONS; ENDOVASCULAR THERAPY; IMAGING SELECTION; BRAIN PERFUSION; THEORETIC BASIS; INFARCT VOLUME; PART; PENUMBRA;

D O I：

10.1371/journal.pone.0141571

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up. Materials and Methods This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0). Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT >= 145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT) and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT) regions. False discovery ratio (FDR), defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT) were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests. Results Median total CTP ischemic core volume was 49.7ml (IQR: 29.9ml-132ml); median misclassified ischemic core volume was 30.4ml (IQR: 20.9ml-77.0ml). Median FDR between patients was 62% (IQR: 49%-80%). Median relative mean transit time was 243% (IQR: 198%-289%) and 342% (IQR: 249%-432%) for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR: 1.43-1.79) ml/100g (P<0.01) and 1.38 (IQR: 1.15-1.49) ml/100g (P<0.01) for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly. Conclusion For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly differed between ischemic lesion agreement and misclassified CTP ischemic core, suggesting that CTP analysis may benefit from revisions.

引用

页数：15

共 46 条

[1] Imaging of Stroke: Part 1, Perfusion CT-Overview of Imaging Technique, Interpretation Pearls, and Common Pitfalls [J].

Allmendinger, Andrew Mark ;

Tang, Elizabeth R. ;

Lui, Yvonne W. ;

Spektor, Vadim .

AMERICAN JOURNAL OF ROENTGENOLOGY, 2012, 198 (01) :52-62

[2] Comparison of CT perfusion summary maps to early diffusion-weighted images in suspected acute middle cerebral artery stroke [J].

Benson, John ;

Payabvash, Seyedmehdi ;

Salazar, Pascal ;

Jagadeesan, Bharathi ;

Palmer, Christopher S. ;

Truwit, Charles L. ;

McKinney, Alexander M. .

EUROPEAN JOURNAL OF RADIOLOGY, 2015, 84 (04) :682-689

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Recognizing False Ischemic Penumbras in CT Brain Perfusion Studies [J].

Best, Alan C. ;

Acosta, Natasha R. ;

Fraser, Jennifer E. ;

Borges, Manuel T. ;

Brega, Kerry E. ;

Anderson, Tracey ;

Neumann, Robert T. ;

Ree, Alexander ;

Bert, Robert J. .

RADIOGRAPHICS, 2012, 32 (04) :1179-+

[5] Automated Cerebral Infarct Volume Measurement in Follow-up Noncontrast CT Scans of Patients with Acute Ischemic Stroke [J].

Boers, A. M. ;

Marquering, H. A. ;

Jochem, J. J. ;

Besselink, N. J. ;

Berkhemer, O. A. ;

van der Lugt, A. ;

Beenen, L. F. ;

Majoie, C. B. .

AMERICAN JOURNAL OF NEURORADIOLOGY, 2013, 34 (08) :1522-1527

[6] Effect of Extended CT Perfusion Acquisition Time on Ischemic Core and Penumbra Volume Estimation in Patients with Acute Ischemic Stroke due to a Large Vessel Occlusion [J].

Borst, Jordi ;

Marquering, Henk A. ;

Beenen, Ludo F. M. ;

Berkhemer, Olvert A. ;

Dankbaar, Jan Willem ;

Riordan, Alan J. ;

Majoie, Charles B. L. M. .

PLOS ONE, 2015, 10 (03)

[7] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[8] Imaging selection in ischemic stroke: feasibility of automated CT-perfusion analysis [J].

Campbell, Bruce C. V. ;

Yassi, Nawaf ;

Ma, Henry ;

Sharma, Gagan ;

Salinas, Simon ;

Churilov, Leonid ;

Meretoja, Atte ;

Parsons, Mark W. ;

Desmond, Patricia M. ;

Lansberg, Maarten G. ;

Donnan, Geoffrey A. ;

Davis, Stephen M. .

INTERNATIONAL JOURNAL OF STROKE, 2015, 10 (01) :51-54

[9] Comparison of Computed Tomography Perfusion and Magnetic Resonance Imaging Perfusion-Diffusion Mismatch in Ischemic Stroke [J].

Campbell, Bruce C. V. ;

Christensen, Soren ;

Levi, Christopher R. ;

Desmond, Patricia M. ;

Donnan, Geoffrey A. ;

Davis, Stephen M. ;

Parsons, Mark W. .

STROKE, 2012, 43 (10) :2648-2653

[10] Assessing Response to Stroke Thrombolysis Validation of 24-Hour Multimodal Magnetic Resonance Imaging [J].

Campbell, Bruce C. V. ;

Tu, Hans T. H. ;

Christensen, Soren ;

Desmond, Patricia M. ;

Levi, Christopher R. ;

Bladin, Christopher F. ;

Hjort, Niels ;

Ashkanian, Mahmoud ;

Solling, Christine ;

Donnan, Geoffrey A. ;

Davis, Stephen M. ;

Ostergaard, Leif ;

Parsons, Mark W. .

ARCHIVES OF NEUROLOGY, 2012, 69 (01) :46-50

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