학술논문
Can CT perfusion accurately assess infarct core?
Document Type
Academic Journal
Author
Source
Neurovascular Imaging. March 15, 2016, Vol. 2 Issue 1
Subject
Language
English
Abstract
Author(s): Dan C. Huynh[sup.1], Mark W. Parsons[sup.2], Max Wintermark[sup.3], Achala Vagal[sup.4], Christopher D. d'Esterre[sup.5], Rita Vitorino[sup.1], Daniel Efkehari[sup.1], Jesse Knight[sup.1], Thien J. Huynh[sup.1], Andrew Bivard[sup.6], Rick Swartz[sup.7], Sean Symons[sup.1] and [...]
Background We sought to quantify CTP-derived infarct core applying previously published perfusion thresholds to multi-institutional CTP data to assess the margin of error for 25 mL and 70 mL critical volume thresholds using early DWI as a reference standard. Methods 60 patients with acute ischemic stroke undergoing CTP and DWI within 6 and 24 h of symptom onset, respectively, were retrospectively analyzed from 3 tertiary care centers. CTP-derived infarct core was calculated using published thresholds for absolute and relative CBF and CBV in addition to manual CBV tracing. Using DWI as the reference standard, performance of CTP-derived measures of infarct core was assessed using co-registered voxel-by-voxel analysis and total infarct volume comparison. Volumes of each CTP infarct core estimate were compared against DWI to determine the degree of infarct core over or underestimation at the critical volumes of 25 mL and 70 mL. Results Median core infarct volume was 10.8 mL. Mean CTP-derived infarct core volumes were similar to DWI for all CTP threshold methods to within [+ or -] 1 mL. CBV tracing demonstrated an overall significant core overestimation compared to DWI (p = 0.017). All CTP core volume estimations showed robust correlation with DWI (Pearson p-value < 0.001). As core volume increased, CTP demonstrated increased deviation from DWI. At the critical cut-offs of 25 mL and 70 mL, relative CBF demonstrated the best agreement with DWI for infarct core compared to the other CTP-derived measures of infarct core. Conclusion Our study demonstrates close approximation between multiple CTP-derived measures of infarct core and DWI infarct volume, Especially relative CBF. Keywords: Infarct Volume, Infarct Core, Core Volume, Time Density Curve, Intermodality Agreement
Background We sought to quantify CTP-derived infarct core applying previously published perfusion thresholds to multi-institutional CTP data to assess the margin of error for 25 mL and 70 mL critical volume thresholds using early DWI as a reference standard. Methods 60 patients with acute ischemic stroke undergoing CTP and DWI within 6 and 24 h of symptom onset, respectively, were retrospectively analyzed from 3 tertiary care centers. CTP-derived infarct core was calculated using published thresholds for absolute and relative CBF and CBV in addition to manual CBV tracing. Using DWI as the reference standard, performance of CTP-derived measures of infarct core was assessed using co-registered voxel-by-voxel analysis and total infarct volume comparison. Volumes of each CTP infarct core estimate were compared against DWI to determine the degree of infarct core over or underestimation at the critical volumes of 25 mL and 70 mL. Results Median core infarct volume was 10.8 mL. Mean CTP-derived infarct core volumes were similar to DWI for all CTP threshold methods to within [+ or -] 1 mL. CBV tracing demonstrated an overall significant core overestimation compared to DWI (p = 0.017). All CTP core volume estimations showed robust correlation with DWI (Pearson p-value < 0.001). As core volume increased, CTP demonstrated increased deviation from DWI. At the critical cut-offs of 25 mL and 70 mL, relative CBF demonstrated the best agreement with DWI for infarct core compared to the other CTP-derived measures of infarct core. Conclusion Our study demonstrates close approximation between multiple CTP-derived measures of infarct core and DWI infarct volume, Especially relative CBF. Keywords: Infarct Volume, Infarct Core, Core Volume, Time Density Curve, Intermodality Agreement