Is limited-coverage CT perfusion helpful in treatment decision-making in patients with acute ischemic stroke?

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11120%2F20%3A43920574" target="_blank" >RIV/00216208:11120/20:43920574 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11130/20:10415032 RIV/00216208:11210/20:10415032 RIV/00064173:_____/20:N0000144

Výsledek na webu

<a href="https://doi.org/10.21037/QIMS-20-555" target="_blank" >https://doi.org/10.21037/QIMS-20-555</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.21037/QIMS-20-555" target="_blank" >10.21037/QIMS-20-555</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Is limited-coverage CT perfusion helpful in treatment decision-making in patients with acute ischemic stroke?

Popis výsledku v původním jazyce

Background: The initial core infarct volume predicts treatment outcome in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). According to the literature, CT perfusion (CTP) is able to evaluate cerebral parenchymal viability and assess the initial core in AIS. We prospectively studied whether limited-coverage CTP with automated core calculation correlates with the final infarct volume on follow-up non-enhanced CT (NECT) in patients successfully treated by mechanical thrombectomy. Methods: We enrolled 31 stroke patients (20 women aged 74.4+-12.9 years and 11 men aged 66+-15.4 years; median initial NIHSS score 15.5) with occlusion of the medial cerebral artery and/or the internal carotid artery that were treated by successful mechanical thrombectomy. CTP performed in a 38.6 mm slab at the level of basal ganglia was included in the CT stroke protocol, but was not used to determine indication for mechanical thrombectomy. The infarction core volume based on CTP was automatically calculated using dedicated software with a threshold defined as cerebral blood flow &lt;30% of the value in the contralateral healthy hemisphere. The final infarction volume was measured on 24-hour follow-up NECT in the same slab with respect to CTP. Pearson and Spearman correlation coefficients and robust linear regression were used for comparison of both volumes, P values &lt;0.05 were considered as statistically significant. Results: The median time from stroke onset to CT was 77 minutes (range, 31-284 minutes), and the median time from CT to vessel recanalization was 95 minutes (range, 55-215 minutes). The mean CTP-calculated core infarct volume was 24.3+-19.2 mL (median 19 mL, range 1-79 mL), while the mean final infarct volume was 21.5+-39.5 mL (median 8 mL; range 0-210 mL). Only a weak relationship was found between the CTP-calculated core and final infarct volume [Pr(29) =0.32, P=0.078; rho =0.40, P=0.028]. Regression analysis showed CTP significantly overestimated lower volumes. Conclusions: In our prospective study, the infarction core calculated using limited-coverage CTP only weakly correlated with the final infarction volume measured on 24-hour follow-up NECT; moreover, CTP significantly overestimated lower volumes. Our results do not support the use of limited-coverage CTP for guiding treatment recommendations in patients with AIS.

Název v anglickém jazyce

Is limited-coverage CT perfusion helpful in treatment decision-making in patients with acute ischemic stroke?

Popis výsledku anglicky

Background: The initial core infarct volume predicts treatment outcome in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). According to the literature, CT perfusion (CTP) is able to evaluate cerebral parenchymal viability and assess the initial core in AIS. We prospectively studied whether limited-coverage CTP with automated core calculation correlates with the final infarct volume on follow-up non-enhanced CT (NECT) in patients successfully treated by mechanical thrombectomy. Methods: We enrolled 31 stroke patients (20 women aged 74.4+-12.9 years and 11 men aged 66+-15.4 years; median initial NIHSS score 15.5) with occlusion of the medial cerebral artery and/or the internal carotid artery that were treated by successful mechanical thrombectomy. CTP performed in a 38.6 mm slab at the level of basal ganglia was included in the CT stroke protocol, but was not used to determine indication for mechanical thrombectomy. The infarction core volume based on CTP was automatically calculated using dedicated software with a threshold defined as cerebral blood flow &lt;30% of the value in the contralateral healthy hemisphere. The final infarction volume was measured on 24-hour follow-up NECT in the same slab with respect to CTP. Pearson and Spearman correlation coefficients and robust linear regression were used for comparison of both volumes, P values &lt;0.05 were considered as statistically significant. Results: The median time from stroke onset to CT was 77 minutes (range, 31-284 minutes), and the median time from CT to vessel recanalization was 95 minutes (range, 55-215 minutes). The mean CTP-calculated core infarct volume was 24.3+-19.2 mL (median 19 mL, range 1-79 mL), while the mean final infarct volume was 21.5+-39.5 mL (median 8 mL; range 0-210 mL). Only a weak relationship was found between the CTP-calculated core and final infarct volume [Pr(29) =0.32, P=0.078; rho =0.40, P=0.028]. Regression analysis showed CTP significantly overestimated lower volumes. Conclusions: In our prospective study, the infarction core calculated using limited-coverage CTP only weakly correlated with the final infarction volume measured on 24-hour follow-up NECT; moreover, CTP significantly overestimated lower volumes. Our results do not support the use of limited-coverage CTP for guiding treatment recommendations in patients with AIS.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30224 - Radiology, nuclear medicine and medical imaging

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2020

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Quantitative Imaging in Medicine and Surgery

ISSN

2223-4292

e-ISSN

—

Svazek periodika

10

Číslo periodika v rámci svazku

10

Stát vydavatele periodika

CN - Čínská lidová republika

Počet stran výsledku

9

Strana od-do

1908-1916

Kód UT WoS článku

000569098000002

EID výsledku v databázi Scopus

2-s2.0-85090738795