Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke

Jan W. Hoving; Henk A. Marquering; Charles B. L. M. Majoie; Nawaf Yassi; Gagan Sharma; David S. Liebeskind; Aad van der Lugt; Yvo B. Roos; Wim van Zwam; Robert J. van Oostenbrugge; Mayank Goyal; Jeffrey L. Saver; Tudor G. Jovin; Gregory W. Albers; Antoni Davalos; Michael D. Hill; Andrew M. Demchuk; Serge Bracard; Francis Guillemin; Keith W. Muir; Philip White; Peter J. Mitchell; Geoffrey A. Donnan; Stephen M. Davis; Bruce C. V. Campbell

doi:10.1161/STROKEAHA.118.020846

Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke

Jan W. Hoving, Henk A. Marquering, Charles B. L. M. Majoie, Nawaf Yassi, Gagan Sharma, David S. Liebeskind, Aad van der Lugt, Yvo B. Roos, Wim van Zwam, Robert J. van Oostenbrugge, Mayank Goyal, Jeffrey L. Saver, Tudor G. Jovin, Gregory W. Albers, Antoni Davalos, Michael D. Hill, Andrew M. Demchuk, Serge Bracard, Francis Guillemin, Keith W. MuirPhilip White, Peter J. Mitchell, Geoffrey A. Donnan, Stephen M. Davis, Bruce C. V. Campbell^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

53 Citations (Web of Science)

Abstract

Background and Purpose-The volume of estimated ischemic core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic core in patients with successful endovascular reperfusion.

Methods-Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic core volume on baseline CTP data was estimated using relative cerebral blood flow

Results-In 120 patients, median CTP estimated ischemic core volume was 7.8 mL (IQR, 1.8-19.9 mL), and median diffusion lesion volume at 24 hours was 30.8 mL (IQR, 14.9-67.6 mL). Median volumetric difference was 4.4 mL (IQR, 1.2-12.0 mL). Dice similarity coefficient was low (median, 0.24; IQR, 0.15-0.37). The median precision (positive predictive value) of 0.68 (IQR, 0.40-0.88) and average Hausdorff distance (median, 3.1; IQR, 1.8-5.7 mm) indicated reasonable spatial agreement for regions estimated as ischemic core at baseline. Overestimation of total ischemic core volume by CTP was uncommon. Expert visual review revealed overestimation predominantly in white matter regions.

Conclusions-CTP estimated ischemic core volumes were substantially smaller than follow-up diffusion-weighted imaging lesions at 24 hours despite endovascular reperfusion within 2 hours of imaging. This may be partly because of infarct growth. Volumetric CTP core overestimation was uncommon and not related to imaging-to-reperfusion time. Core overestimation in white matter should be a focus of future efforts to improve CTP accuracy.

Original language	English
Pages (from-to)	2368-2375
Number of pages	8
Journal	Stroke
Volume	49
Issue number	10
DOIs	https://doi.org/10.1161/STROKEAHA.118.020846
Publication status	Published - Oct 2018

Keywords

cerebral infarction
magnetic resonance imaging
reperfusion
tenecteplase
thrombectomy
tomography, X-ray computed
TISSUE-PLASMINOGEN ACTIVATOR
CEREBRAL-BLOOD-FLOW
CT PERFUSION
ENDOVASCULAR THERAPY
INFARCT VOLUME
THROMBECTOMY
DIFFUSION
SOFTWARE
SELECTION
PREDICT

Access to Document

10.1161/STROKEAHA.118.020846

Cite this

Hoving, J. W., Marquering, H. A., Majoie, C. B. L. M., Yassi, N., Sharma, G., Liebeskind, D. S., van der Lugt, A., Roos, Y. B., van Zwam, W., van Oostenbrugge, R. J., Goyal, M., Saver, J. L., Jovin, T. G., Albers, G. W., Davalos, A., Hill, M. D., Demchuk, A. M., Bracard, S., Guillemin, F., ... Campbell, B. C. V. (2018). Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke. Stroke, 49(10), 2368-2375. https://doi.org/10.1161/STROKEAHA.118.020846

@article{1039301a73ae499d8215558d65133074,

title = "Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke",

abstract = "Background and Purpose-The volume of estimated ischemic core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic core in patients with successful endovascular reperfusion.Methods-Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic core volume on baseline CTP data was estimated using relative cerebral blood flowResults-In 120 patients, median CTP estimated ischemic core volume was 7.8 mL (IQR, 1.8-19.9 mL), and median diffusion lesion volume at 24 hours was 30.8 mL (IQR, 14.9-67.6 mL). Median volumetric difference was 4.4 mL (IQR, 1.2-12.0 mL). Dice similarity coefficient was low (median, 0.24; IQR, 0.15-0.37). The median precision (positive predictive value) of 0.68 (IQR, 0.40-0.88) and average Hausdorff distance (median, 3.1; IQR, 1.8-5.7 mm) indicated reasonable spatial agreement for regions estimated as ischemic core at baseline. Overestimation of total ischemic core volume by CTP was uncommon. Expert visual review revealed overestimation predominantly in white matter regions.Conclusions-CTP estimated ischemic core volumes were substantially smaller than follow-up diffusion-weighted imaging lesions at 24 hours despite endovascular reperfusion within 2 hours of imaging. This may be partly because of infarct growth. Volumetric CTP core overestimation was uncommon and not related to imaging-to-reperfusion time. Core overestimation in white matter should be a focus of future efforts to improve CTP accuracy.",

keywords = "cerebral infarction, magnetic resonance imaging, reperfusion, tenecteplase, thrombectomy, tomography, X-ray computed, TISSUE-PLASMINOGEN ACTIVATOR, CEREBRAL-BLOOD-FLOW, CT PERFUSION, ENDOVASCULAR THERAPY, INFARCT VOLUME, THROMBECTOMY, DIFFUSION, SOFTWARE, SELECTION, PREDICT",

author = "Hoving, {Jan W.} and Marquering, {Henk A.} and Majoie, {Charles B. L. M.} and Nawaf Yassi and Gagan Sharma and Liebeskind, {David S.} and {van der Lugt}, Aad and Roos, {Yvo B.} and {van Zwam}, Wim and {van Oostenbrugge}, {Robert J.} and Mayank Goyal and Saver, {Jeffrey L.} and Jovin, {Tudor G.} and Albers, {Gregory W.} and Antoni Davalos and Hill, {Michael D.} and Demchuk, {Andrew M.} and Serge Bracard and Francis Guillemin and Muir, {Keith W.} and Philip White and Mitchell, {Peter J.} and Donnan, {Geoffrey A.} and Davis, {Stephen M.} and Campbell, {Bruce C. V.}",

year = "2018",

month = oct,

doi = "10.1161/STROKEAHA.118.020846",

language = "English",

volume = "49",

pages = "2368--2375",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "10",

}

Hoving, JW, Marquering, HA, Majoie, CBLM, Yassi, N, Sharma, G, Liebeskind, DS, van der Lugt, A, Roos, YB, van Zwam, W , van Oostenbrugge, RJ, Goyal, M, Saver, JL, Jovin, TG, Albers, GW, Davalos, A, Hill, MD, Demchuk, AM, Bracard, S, Guillemin, F, Muir, KW, White, P, Mitchell, PJ, Donnan, GA, Davis, SM & Campbell, BCV 2018, 'Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke', Stroke, vol. 49, no. 10, pp. 2368-2375. https://doi.org/10.1161/STROKEAHA.118.020846

TY - JOUR

T1 - Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke

AU - Hoving, Jan W.

AU - Marquering, Henk A.

AU - Majoie, Charles B. L. M.

AU - Yassi, Nawaf

AU - Sharma, Gagan

AU - Liebeskind, David S.

AU - van der Lugt, Aad

AU - Roos, Yvo B.

AU - van Zwam, Wim

AU - van Oostenbrugge, Robert J.

AU - Goyal, Mayank

AU - Saver, Jeffrey L.

AU - Jovin, Tudor G.

AU - Albers, Gregory W.

AU - Davalos, Antoni

AU - Hill, Michael D.

AU - Demchuk, Andrew M.

AU - Bracard, Serge

AU - Guillemin, Francis

AU - Muir, Keith W.

AU - White, Philip

AU - Mitchell, Peter J.

AU - Donnan, Geoffrey A.

AU - Davis, Stephen M.

AU - Campbell, Bruce C. V.

PY - 2018/10

Y1 - 2018/10

N2 - Background and Purpose-The volume of estimated ischemic core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic core in patients with successful endovascular reperfusion.Methods-Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic core volume on baseline CTP data was estimated using relative cerebral blood flowResults-In 120 patients, median CTP estimated ischemic core volume was 7.8 mL (IQR, 1.8-19.9 mL), and median diffusion lesion volume at 24 hours was 30.8 mL (IQR, 14.9-67.6 mL). Median volumetric difference was 4.4 mL (IQR, 1.2-12.0 mL). Dice similarity coefficient was low (median, 0.24; IQR, 0.15-0.37). The median precision (positive predictive value) of 0.68 (IQR, 0.40-0.88) and average Hausdorff distance (median, 3.1; IQR, 1.8-5.7 mm) indicated reasonable spatial agreement for regions estimated as ischemic core at baseline. Overestimation of total ischemic core volume by CTP was uncommon. Expert visual review revealed overestimation predominantly in white matter regions.Conclusions-CTP estimated ischemic core volumes were substantially smaller than follow-up diffusion-weighted imaging lesions at 24 hours despite endovascular reperfusion within 2 hours of imaging. This may be partly because of infarct growth. Volumetric CTP core overestimation was uncommon and not related to imaging-to-reperfusion time. Core overestimation in white matter should be a focus of future efforts to improve CTP accuracy.

AB - Background and Purpose-The volume of estimated ischemic core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic core in patients with successful endovascular reperfusion.Methods-Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic core volume on baseline CTP data was estimated using relative cerebral blood flowResults-In 120 patients, median CTP estimated ischemic core volume was 7.8 mL (IQR, 1.8-19.9 mL), and median diffusion lesion volume at 24 hours was 30.8 mL (IQR, 14.9-67.6 mL). Median volumetric difference was 4.4 mL (IQR, 1.2-12.0 mL). Dice similarity coefficient was low (median, 0.24; IQR, 0.15-0.37). The median precision (positive predictive value) of 0.68 (IQR, 0.40-0.88) and average Hausdorff distance (median, 3.1; IQR, 1.8-5.7 mm) indicated reasonable spatial agreement for regions estimated as ischemic core at baseline. Overestimation of total ischemic core volume by CTP was uncommon. Expert visual review revealed overestimation predominantly in white matter regions.Conclusions-CTP estimated ischemic core volumes were substantially smaller than follow-up diffusion-weighted imaging lesions at 24 hours despite endovascular reperfusion within 2 hours of imaging. This may be partly because of infarct growth. Volumetric CTP core overestimation was uncommon and not related to imaging-to-reperfusion time. Core overestimation in white matter should be a focus of future efforts to improve CTP accuracy.

KW - cerebral infarction

KW - magnetic resonance imaging

KW - reperfusion

KW - tenecteplase

KW - thrombectomy

KW - tomography, X-ray computed

KW - TISSUE-PLASMINOGEN ACTIVATOR

KW - CEREBRAL-BLOOD-FLOW

KW - CT PERFUSION

KW - ENDOVASCULAR THERAPY

KW - INFARCT VOLUME

KW - THROMBECTOMY

KW - DIFFUSION

KW - SOFTWARE

KW - SELECTION

KW - PREDICT

U2 - 10.1161/STROKEAHA.118.020846

DO - 10.1161/STROKEAHA.118.020846

M3 - Article

C2 - 30355095

SN - 0039-2499

VL - 49

SP - 2368

EP - 2375

JO - Stroke

JF - Stroke

IS - 10

ER -