Whole brain CT perfusion in acute anterior circulation ischemia: coverage size matters
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Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice.
In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level.
Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10 % as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4 % for the 8-cm, 7 % for the 4-cm, and 13 % for the 3-cm coverage size.
This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage.
KeywordsCT perfusion Whole brain Infarct core Stroke
Ethical standards and patient consent
We declare that all human and animal studies have been approved by the Medical Ethical Committee of the Leiden University Medical Centre and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
Conflict of interest
We declare that we have no conflict of interest.
- 2.Biesbroek JM, Niesten JM, Dankbaar JW, Biessels GJ, Velthuis BK, Reitsma JB, van der Schaaf IC (2013) Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis 35(6):493–501. doi: 10.1159/000350200 PubMedCrossRefGoogle Scholar
- 4.Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923. doi: 10.1056/NEJMoa1212793 PubMedCentralPubMedCrossRefGoogle Scholar
- 5.Kidwell CS, Wintermark M, De Silva DA, Schaewe TJ, Jahan R, Starkman S, Jovin T, Hom J, Jumaa M, Schreier J, Gornbein J, Liebeskind DS, Alger JR, Saver JL (2013) Multiparametric MRI and CT models of infarct core and favorable penumbral imaging patterns in acute ischemic stroke. Stroke 44(1):73–79. doi: 10.1161/STROKEAHA.112.670034 PubMedCentralPubMedCrossRefGoogle Scholar
- 6.Yoo AJ, Verduzco LA, Schaefer PW, Hirsch JA, Rabinov JD, Gonzalez RG (2009) MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 40(6):2046–2054. doi: 10.1161/STROKEAHA.108.541656 PubMedCentralPubMedCrossRefGoogle Scholar
- 8.Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39(4):1205–1212. doi: 10.1161/STROKEAHA.107.497115 PubMedCrossRefGoogle Scholar
- 11.Rai AT, Raghuram K, Domico J, Hobbs G, Carpenter J (2012) Pre-intervention triage incorporating perfusion imaging improves outcomes in patients undergoing endovascular stroke therapy: a comparison with the device trials. J of neurointerventional surg. doi: 10.1136/neurintsurg-2011-010189 Google Scholar
- 12.Turk AS, Magarick JA, Frei D, Fargen KM, Chaudry I, Holmstedt CA, Nicholas J, Mocco J, Turner RD, Huddle D, Loy D, Bellon R, Dooley G, Adams R, Whaley M, Fanale C, Jauch E (2012) CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study. J of neurointerventional surg. doi: 10.1136/neurintsurg-2012-010491 Google Scholar
- 14.Schaefer PW, Barak ER, Kamalian S, Gharai LR, Schwamm L, Gonzalez RG, Lev MH (2008) Quantitative assessment of core/penumbra mismatch in acute stroke: CT and MR perfusion imaging are strongly correlated when sufficient brain volume is imaged. Stroke 39(11):2986–2992. doi: 10.1161/STROKEAHA.107.513358 PubMedCrossRefGoogle Scholar
- 16.Murphy BD, Fox AJ, Lee DH, Sahlas DJ, Black SE, Hogan MJ, Coutts SB, Demchuk AM, Goyal M, Aviv RI, Symons S, Gulka IB, Beletsky V, Pelz D, Chan RK, Lee TY (2008) White matter thresholds for ischemic penumbra and infarct core in patients with acute stroke: CT perfusion study. Radiology 247(3):818–825. doi: 10.1148/radiol.2473070551 PubMedCrossRefGoogle Scholar
- 17.Wintermark M, Smith WS, Ko NU, Quist M, Schnyder P, Dillon WP (2004) Dynamic perfusion CT: optimizing the temporal resolution and contrast volume for calculation of perfusion CT parameters in stroke patients. AJNR Am j of neuroradiol 25(5):720–729Google Scholar
- 18.Kamena A, Streitparth F, Grieser C, Lehmkuhl L, Jamil B, Wojtal K, Ricke J, Pech M (2007) Dynamic perfusion CT: optimizing the temporal resolution for the calculation of perfusion CT parameters in stroke patients. Eur J Radiol 64(1):111–118. doi: 10.1016/j.ejrad.2007.02.025 PubMedCrossRefGoogle Scholar
- 19.Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, Anderson J, Nesbit G, Gabriely I, Medina V, Quiles A, Pohlman S, Quist M, Schnyder P, Bogousslavsky J, Dillon WP, Pedraza S (2006) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 37(4):979–985. doi: 10.1161/01.STR.0000209238.61459.39 PubMedCrossRefGoogle Scholar