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Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

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Abstract

Objectives

CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy.

Methods

Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score.

Results

Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively.

Conclusions

CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy.

Key Points

• CBV-ASPECTS is a significant predictor of clinical outcome.

• Single phase CTA-ASPECTS has low predictive value.

• Using CBV-ASPECTS, raters identified futile reperfusions in 96 % of the cases.

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Abbreviations

ASPECTS:

Alberta stroke program early CT score

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

GSS:

Goettinger stroke scale

ICC:

Interclass correlation coefficient

IQR:

Interquartile range

IV rtPA:

Intravenous recombinant tissue plasminogen activator

MCA:

Middle cerebral artery

mTICI:

Modified thrombolysis in cerebral infarction

MTT:

Mean transit time

mRS:

Modified Rankin scale

NIHSS:

National Institutes of Health stroke scale

NCCT:

noncontrast computed tomography

NPV:

Negative predictive value

PPV:

Positive predictive value

TTD:

Time to drain

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Acknowledgments

The scientific guarantor of this publication is Dr. Marios Nikos Psychogios. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. We would like to inform you that part of the current patient collective (about one-third of the population) has been subject to previous analyses: Frölich AM, Wolff SL, Psychogios MN et al. (2014) Time-resolved assessment of collateral flow using 4D CT angiography in large-vessel occlusion stroke. Eur Radiol 24(2):390-6. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany

    Ioannis Tsogkas, Michael Knauth, Katharina Schregel, Daniel Behme & Marios Nikos Psychogios

  2. Department of Neurology, University Medicine Goettingen, Goettingen, Germany

    Katrin Wasser, Ilko Maier & Jan Liman

Authors
  1. Ioannis Tsogkas
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  2. Michael Knauth
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  3. Katharina Schregel
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  4. Daniel Behme
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  5. Katrin Wasser
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  6. Ilko Maier
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  7. Jan Liman
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  8. Marios Nikos Psychogios
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Correspondence to Marios Nikos Psychogios.

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Tsogkas, I., Knauth, M., Schregel, K. et al. Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy. Eur Radiol 26, 4213–4219 (2016). https://doi.org/10.1007/s00330-016-4257-y

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  • DOI: https://doi.org/10.1007/s00330-016-4257-y

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