Top

European Radiology

Published in:

01-12-2012 | Neuro

Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging

Authors: Benjamin Abels, J. Pablo Villablanca, Bernd F. Tomandl, Michael Uder, Michael M. Lell

Published in: European Radiology | Issue 12/2012

Abstract

Objectives

To compare ischaemic lesions predicted by different CT perfusion (CTP) post-processing techniques and validate CTP lesions compared with final lesion size in stroke patients.

Methods

Fifty patients underwent CT, CTP and CT angiography. Quantitative values and colour maps were calculated using least mean square deconvolution (LMSD), maximum slope (MS) and conventional singular value decomposition deconvolution (SVDD) algorithms. Quantitative results, core/penumbra lesion sizes and Alberta Stroke Programme Early CT Score (ASPECTS) were compared among the algorithms; lesion sizes and ASPECTS were compared with final lesions on follow-up MRI + MRA or CT + CTA as a reference standard, accounting for recanalisation status.

Results

Differences in quantitative values and lesion sizes were statistically significant, but therapeutic decisions based on ASPECTS and core/penumbra ratios would have been the same in all cases. CTP lesion sizes were highly predictive of final infarct size: Coefficients of determination (R ²) for CTP versus follow-up lesion sizes in the recanalisation group were 0.87, 0.82 and 0.61 (P < 0.001) for LMSD, MS and SVDD, respectively, and 0.88, 0.87 and 0.76 (P < 0.001), respectively, in the non-recanalisation group.

Conclusions

Lesions on CT perfusion are highly predictive of final infarct. Different CTP post-processing algorithms usually lead to the same clinical decision, but for assessing lesion size, LMSD and MS appear superior to SVDD.

Key Points

• Following an acute stroke, CT perfusion imaging can help predict lesion evolution.

• Delay-insensitive deconvolution and maximum slope approach are superior to delay-sensitive deconvolution regarding accuracy.

• Different CT perfusion post-processing algorithms usually lead to the same clinical decision.

• CT perfusion offers new insights into the evolution of stroke.

Available only for authorised users

Miles KA, Hayball M, Dixon AK (1991) Colour perfusion imaging: a new application of computed tomography. Lancet 337:643–645PubMedCrossRef

Hopyan J, Ciarallo A, Dowlatshahi D et al (2010) Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography. Radiology 255:142–153PubMedCrossRef

Kloska SP, Nabavi DG, Gaus C et al (2004) Acute stroke assessment with CT: do we need multimodal evaluation? Radiology 233:79–86PubMedCrossRef

Wintermark M, Fischbein NJ, Smith WS, Ko NU, Quist M, Dillon WP (2005) Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke. AJNR Am J Neuroradiol 26:104–112PubMed

Roberts HC, Dillon WP, Furlan AJ et al (2002) Computed tomographic findings in patients undergoing intra-arterial thrombolysis for acute ischemic stroke due to middle cerebral artery occlusion: results from the PROACT II trial. Stroke 33:1557–1565PubMedCrossRef

Higashida RT, Furlan AJ, Roberts H et al (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34:e109–e137PubMedCrossRef

König M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L (2001) Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke 32:431–437CrossRef

Wintermark M, Flanders AE, Velthuis B et al (2006) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 37:979–985PubMedCrossRef

Shih LC, Saver JL, Alger JR et al (2003) Perfusion-weighted magnetic resonance imaging thresholds identifying core, irreversibly infarcted tissue. Stroke 34:1425–1430PubMedCrossRef

10.

Kluytmans M, van Everdingen KJ, Kappelle LJ, Ramos LM, Viergever MA, van der Grond J (2000) Prognostic value of perfusion- and diffusion-weighted MR imaging in first 3 days of stroke. Eur Radiol 10:1434–1441PubMedCrossRef

11.

Wintermark M, Rowley HA, Lev MH (2009) Acute stroke triage to intravenous thrombolysis and other therapies with advanced CT or MR imaging: pro CT. Radiology 251:619–626PubMedCrossRef

12.

Wintermark M, Albers GW, Alexandrov AV et al (2008) Acute stroke imaging research roadmap. AJNR Am J Neuroradiol 29:e23–e30PubMedCrossRef

13.

Kudo K, Sasaki M, Yamada K et al (2010) Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology 254:200–209PubMedCrossRef

14.

Adams HP Jr, del Zoppo G, Alberts MJ et al (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 115:e478–e534PubMedCrossRef

15.

Del Zoppo GJ, Saver JL, Jauch EC, Adams HP Jr (2009) Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke 40:2945–2948PubMedCrossRef

16.

Abels B, Klotz E, Tomandl BF, Kloska SP, Lell MM (2010) Perfusion CT in acute ischemic stroke: a qualitative and quantitative comparison of deconvolution and maximum slope approach. Am J Neuroradiol 31:1690–1698PubMedCrossRef

17.

Klotz E, Konig M (1999) Perfusion measurements of the brain: using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke. Eur J Radiol 30:170–184PubMedCrossRef

18.

Østergaard L, Weisskoff RM, Chesler DA, Gyldensted C, Rosen BR (1996) High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis. Magn Reson Med 36:715–725

19.

Pexman JH, Barber PA, Hill MD et al (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22:1534–1542PubMed

20.

Ferreira RM, Lev MH, Goldmakher GV et al (2010) Arterial input function placement for accurate CT perfusion map construction in acute stroke. Am J Roentgenol 194:1330–1336CrossRef

21.

Eastwood JD, Lev MH, Azhari T et al (2002) CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke. Radiology 222:227–236PubMedCrossRef

22.

Wintermark M, Reichhart M, Thiran JP et al (2002) Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 51:417–432PubMedCrossRef

23.

Schramm P, Schellinger PD, Klotz E et al (2004) Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke 35:1652–1658PubMedCrossRef

24.

Schaefer PW, Barak ER, Kamalian S et al (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 39:2986–2992PubMedCrossRef

25.

Dani KA, Thomas RG, Chappell FM et al (2011) Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Ann Neurol 70:384–401PubMedCrossRef

26.

Kloska SP, Dittrich R, Fischer T et al (2007) Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy. Eur Radiol 17:2491–2498PubMedCrossRef

27.

Dorn F, Muenzel D, Meier R, Poppert H, Rummeny EJ, Huber A (2011) Brain perfusion CT for acute stroke using a 256-slice CT: improvement of diagnostic information by large volume coverage. Eur Radiol 21:1803–1810PubMedCrossRef

28.

Buckler AJ, Bresolin L, Dunnick NR et al (2011) Quantitative imaging test approval and biomarker qualification: interrelated but distinct activities. Radiology 259:875–884PubMedCrossRef

Title: Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging
Authors: Benjamin Abels
J. Pablo Villablanca
Bernd F. Tomandl
Michael Uder
Michael M. Lell
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2529-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2012

Low-dose CT of the lung: potential value of iterative reconstructions

Workflow-centred evaluation of an automatic lesion tracking software for chemotherapy monitoring by CT

Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

Spectral CT of carotid atherosclerotic plaque: comparison with histology

Can radiographers be trained to triage CT colonography for extracolonic findings?

Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections