Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds.

Humans Stroke / pathology Magnetic Resonance Imaging Infarction / diagnostic imaging Cerebrovascular Circulation Perfusion Imaging / methods Tomography, X-Ray Computed / methods Perfusion Brain Ischemia / diagnostic imaging

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
09 2022
Historique:
received: 28 03 2022
accepted: 20 06 2022
pubmed: 19 8 2022
medline: 30 12 2022
entrez: 18 8 2022
Statut: ppublish

Résumé

CTP allows estimating ischemic core in patients with acute stroke. However, these estimations have limited accuracy compared with MR imaging. We studied the effect of applying WM- and GM-specific thresholds and analyzed the infarct growth from baseline imaging to reperfusion. This was a single-center cohort of consecutive patients ( The fixed threshold underestimated lesions in GM and overestimated them in WM. Double GM- and WM-specific thresholds of relative CBF were superior to fixed thresholds in predicting infarcted voxels. The closest estimations of the infarct on DWI were based on a relative CBF of 25% for a single threshold, 35% for GM, and 20% for WM, and they decreased when correcting for infarct growth: 20% for a single threshold, 25% for GM, and 15% for WM. The combination of 25% for GM and 15% for WM yielded the best prediction. GM- and WM-specific thresholds result in different estimations of ischemic core in CTP and increase the global accuracy. More restrictive thresholds better estimate the actual extent of the infarcted tissue.

Sections du résumé

BACKGROUND AND PURPOSE
CTP allows estimating ischemic core in patients with acute stroke. However, these estimations have limited accuracy compared with MR imaging. We studied the effect of applying WM- and GM-specific thresholds and analyzed the infarct growth from baseline imaging to reperfusion.
MATERIALS AND METHODS
This was a single-center cohort of consecutive patients (
RESULTS
The fixed threshold underestimated lesions in GM and overestimated them in WM. Double GM- and WM-specific thresholds of relative CBF were superior to fixed thresholds in predicting infarcted voxels. The closest estimations of the infarct on DWI were based on a relative CBF of 25% for a single threshold, 35% for GM, and 20% for WM, and they decreased when correcting for infarct growth: 20% for a single threshold, 25% for GM, and 15% for WM. The combination of 25% for GM and 15% for WM yielded the best prediction.
CONCLUSIONS
GM- and WM-specific thresholds result in different estimations of ischemic core in CTP and increase the global accuracy. More restrictive thresholds better estimate the actual extent of the infarcted tissue.

Identifiants

DOI: 10.3174/ajnr.A7601 PMID: 35981763 PMC: PMC9451632
pubmed: 35981763
pii: ajnr.A7601
doi: 10.3174/ajnr.A7601
pmc: PMC9451632
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1265-1270

Informations de copyright

© 2022 by American Journal of Neuroradiology.

Auteurs

A Rodríguez-Vázquez (A)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
ORCID: 0000-0002-3448-9778

C Laredo (C)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
ORCID: 0000-0002-4626-6360

A Renú (A)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0001-9169-6856

S Rudilosso (S)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0002-8775-6884

L Llull (L)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0002-1464-2237

S Amaro (S)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0001-6838-6390

V Obach (V)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0002-0518-1053

V Vera (V)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
ORCID: 0000-0002-7039-7440

A Páez (A)

Radiology Department (A.P., L.O.), Hospital Clínic, Barcelona, Spain.
ORCID: 0000-0001-9791-5888

L Oleaga (L)

Radiology Department (A.P., L.O.), Hospital Clínic, Barcelona, Spain.
ORCID: 0000-0001-9702-0451

X Urra (X)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases xurra@clinic.cat.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0002-4763-5252

Á Chamorro (Á)

From the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
University of Barcelona (A.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain.
ORCID: 0000-0003-0493-5340

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Optimizing the Definition of Ischemic Core in...
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questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic radioisotopique › Scintigraphie › Imagerie de perfusion › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › Techniques d'investigation › Perfusion › Optimizing the Definition of Ischemic Core in...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Optimizing the Definition of Ischemic Core in...