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López-Rueda A, Ibáñez Sanz L, Alonso de Leciñana M, de Araújo Martins-Romeo D, Vicente Bartulos A, Castellanos Rodrigo M, Oleaga Zufiria L. Recommendations on the use of computed tomography in the stroke code: Consensus document SENR, SERAU, GEECV-SEN, SERAM. RADIOLOGIA 2023; 65:180-191. [PMID: 37059583 DOI: 10.1016/j.rxeng.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/18/2022] [Indexed: 03/31/2023]
Abstract
The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes.
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Affiliation(s)
- A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic, Barcelona, Spain.
| | - L Ibáñez Sanz
- Radiología de Urgencias, Hospital 12 de Octubre, Madrid, Spain
| | - M Alonso de Leciñana
- Servicio de Neurología y Centro de Ictus, Instituto para la Investigación biomédica-Hospital Universitario la Paz (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | | | - A Vicente Bartulos
- Sección de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Castellanos Rodrigo
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - L Oleaga Zufiria
- Sección Radiología Vascular e Intervencionista, Hospital Clínic, Barcelona, Spain
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López-Rueda A, Ibáñez Sanz L, Alonso de Leciñana M, de Araújo Martins-Romeo D, Vicente Bartulos A, Castellanos Rodrigo M, Oleaga Zufiria L. Recomendaciones sobre el uso de la tomografía computarizada en el código ictus: Documento de consenso SENR, SERAU, GEECV-SEN, SERAM. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Deak Z, Schuettoff L, Lohse AK, Fabritius M, Reidler P, Forbrig R, Kunz W, Dimitriadis K, Ricke J, Sabel B. Reduction in Radiation Exposure of CT Perfusion by Optimized Imaging Timing Using Temporal Information of the Preceding CT Angiography of the Carotid Artery in the Stroke Protocol. Diagnostics (Basel) 2022; 12:diagnostics12112853. [PMID: 36428913 PMCID: PMC9689781 DOI: 10.3390/diagnostics12112853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/05/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: CT perfusion (CTP) is a fast, robust and widely available but dose-exposing imaging technique for infarct core and penumbra detection. Carotid CT angiography (CTA) can precede CTP in the stroke protocol. Temporal information of the bolus tracking series of CTA could allow for better timing and a decreased number of scans in CTP, resulting in less radiation exposure, if the shortening of CTP does not alter the calculated infarct core and penumbra or the resulting perfusion maps, which are essential for further treatment decisions. (2) Methods: 66 consecutive patients with ischemic stroke proven by follow-up imaging or endovascular intervention were included in this retrospective study approved by the local ethics committee. In each case, six simulated, stepwise shortened CTP examinations were compared with the original data regarding the perfusion maps, infarct core, penumbra and endovascular treatment decision. (3) Results: In simulated CTPs with 26, 28 and 30 scans, the infarct core, penumbra and PRR values were equivalent, and the resulting clinical decision was identical to the original CTP. (4) Conclusions: The temporal information of the bolus tracking series of the carotid CTA can allow for better timing and a lower radiation exposure by eliminating unnecessary scans in CTP.
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Affiliation(s)
- Zsuzsanna Deak
- Imaging Urania, Laurenzerberg 2, 1010 Vienna, Austria
- Correspondence:
| | - Lara Schuettoff
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Ann-Kathrin Lohse
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Fabritius
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Forbrig
- Department of Neuroradiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Kunz
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Konstantin Dimitriadis
- Department of Neurology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Bastian Sabel
- Department of Radiology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
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Ortega-Gutierrez S, Quispe-Orozco D, Schafer S, Farooqui M, Zevallos CB, Dandapat S, Mendez-Ruiz A, Aagaard-Kienitz B, Petersen N, Derdeyn CP. Angiography suite cone-beam CT perfusion for selection of thrombectomy patients: A pilot study. J Neuroimaging 2022; 32:493-501. [PMID: 35315169 PMCID: PMC9314685 DOI: 10.1111/jon.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The availability of cone-beam CT perfusion (CBCTP) in angiography suites may improve large-vessel occlusion (LVO) triage and reduce reperfusion times for patients presenting during extended time window. We aim to evaluate the perfusion maps correlation and agreement between multidetector CT perfusion (MDCTP) and CBCTP when obtained sequentially in patients undergoing endovascular therapy. METHODS This is a prospective, pilot, single-arm interventional cohort study of consecutive patients with anterior circulation LVO. All patients underwent MDCTP and CBCTP prior to endovascular therapy, generating cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-maximum/time to peak contrast concentration maps. We compared the two imaging modalities using three different methods: (1) six regions of interest (ROIs) placed in the anterior circulation territory; (2) ROIs placed in all 10 Alberta Stroke Program Early CT Score regions; and (3) ROI drawn around the entire ischemic area. ROI ratios (unaffected/affected area) were compared for all sequences in each method. We used the intraclass correlation coefficient to calculate the correlation between the studies. Bland-Altman plots were also created to measure the degree of agreement. Finally, a sensitivity analysis was done comparing both modalities in patients with low infarct growth rate. RESULTS Fourteen patients were included (median age 81 years [74-87], 50% males, median National Institutes of Health Stroke Scale 19 [14-22]). Median time between studies was 42 minutes (interquartile range 29-61). Independently of the method used, we found moderate to excellent correlation in CBF, CBV, and MTT between modalities. CBF correlation further improved in patients with low infarct growth. CONCLUSION These results demonstrate promising accuracy of CBCTP in evaluating ischemic tissue in patients presenting with LVO ischemic stroke.
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Affiliation(s)
- Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | | | - Mudassir Farooqui
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | | | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
| | - Beverly Aagaard-Kienitz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nils Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Colin P Derdeyn
- Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA
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Kellner E, Rau A, Demerath T, Reisert M, Urbach H. Contrast Bolus Interference in a Multimodal CT Stroke Protocol. AJNR Am J Neuroradiol 2021; 42:1807-1814. [PMID: 34413063 DOI: 10.3174/ajnr.a7247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Whether CTP is performed before or after CTA varies within multimodal CT stroke protocols. CTA after CTP might show venous filling, and CTP metrics might be disturbed by prior CTA. Therefore, we compared CTP metrics conducted before and after CTA in a large cohort of patients with stroke and analyzed interferences of the CTA bolus with the CTP measurement. MATERIALS AND METHODS We analyzed 1980 patients (368 patients with CTP performed before CTA [group A] versus 1612 patients with CTP performed after [group B]) in a retrospective study. Mean curves, histograms of CTP baseline Hounsfield units, CBF, CBV, time-to-maximum, hypoperfusion, and core volumes were calculated using the software VEOcore. CTA and CTP interferences were analyzed, and a detection and correction method was proposed. RESULTS Mean CTP baseline values were significantly different in both groups (41 versus 45 HU within the groups A and B, respectively). However, perfusion metrics, hypoperfusion, and core volumes yielded no significant differences. In 49 patients, the descending flank of the CTA bolus interfered with the baseline of the CTP measurement, leading to erroneously low CBV values. These errors vanished when a correction method was applied. CONCLUSIONS CTP can be reliably performed after CTA without a relevant net effect on perfusion metrics. However, when measuring CTP after CTA, either a short pause on the order of 30 seconds should be observed or an appropriate correction method should be applied. It may help to avoid excluding patients from mechanical thrombectomy by overestimating infarct cores.
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Affiliation(s)
- E Kellner
- From the Department of Radiology, Medical Physics (E.K., M.R.), Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - A Rau
- Department of Neuroradiology (A.R., T.D., H.U.), Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology (A.R., T.D., H.U.), Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - M Reisert
- From the Department of Radiology, Medical Physics (E.K., M.R.), Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology (A.R., T.D., H.U.), Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
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Automated Processing of Head CT Perfusion Imaging for Ischemic Stroke Triage: A Practical Guide to Quality Assurance and Interpretation. AJR Am J Roentgenol 2021; 217:1401-1416. [PMID: 34259036 DOI: 10.2214/ajr.21.26139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent successful trials of thrombectomy launched a shift to imaging-based patient selection for stroke intervention. Many centers have adopted CT perfusion imaging (CTP) as a routine part of stroke workflow, and the demand for emergent CTP interpretation is growing. Fully automated CTP postprocessing software that rapidly generates standardized color-coded CTP summary maps with minimal user input and with easy accessibility of the software output is increasingly being adopted. Such automated postprocessing greatly streamlines clinical workflow and CTP interpretation for radiologists and other frontline physicians. However, the straightforward interface overshadows the computational complexity of the underlying postprocessing workflow, which, if not carefully examined, predisposes the interpreting physician to diagnostic errors. Using case examples, this article aims to familiarize the general radiologist with interpreting automated CTP software data output in the context of contemporary stroke management, providing a discussion of CTP acquisition and postprocessing, a stepwise guide for CTP quality assurance and troubleshooting, and a framework for avoiding clinically significant CTP interpretative pitfalls in commonly encountered clinical scenarios. Interpreting radiologists should apply the outlined approach for quality assurance and develop a comprehensive search pattern for the identified pitfalls, to ensure accurate CTP interpretation and optimize patient selection for reperfusion.
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Wong SC, Hausegger KA, De Paoli L. Single rotation CTA of extracranial carotids integrated with cerebral CTP provides sufficient quality for decision making in patients with ischaemic stroke. Neuroradiol J 2020; 34:105-112. [PMID: 33263488 DOI: 10.1177/1971400920974584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Large volume computed tomography scanners with 16 cm Z-axis single rotation coverage enable joggle-mode scanning of cerebral computed tomography perfusion and single rotation computed tomography angiography of cervical arteries. Our study aims to evaluate the feasibility of scanning cervical arteries, acquired with single rotation computed tomography angiography during computed tomography perfusion in ischaemic stroke patients. MATERIALS AND METHODS A total of 143 patients were scanned with a single contrast medium injection of 60 ml. Hounsfield units of the cervical arteries and veins were objectively measured and carotid bifurcations were subjectively reviewed. The incidence of artefacts and supra-aortic vessel coverage was recorded. RESULTS Single rotation computed tomography angiography of the neck demonstrated supra-aortic vessels to their origins in 58 (40.6%) patients. Ninety-nine per cent (1140/1152) of arterial segments were adequately opacified (≥150 Hounsfield units). Arteries were adequately contrasted compared to veins in 81.3% (915/1126) of segments. However, the opacification was reversed in 14.0% (158/1126) of segments, indicating a delayed timing of acquisition; 95.5% (273/286) of carotid bifurcations were of good image quality. Measurement of internal carotid artery stenosis in single rotation computed tomography angiography according to the North American Symptomatic Carotid Endarterectomy Trial correlated well with digital subtraction angiography (R=0.87, P<0.05). Significant artefacts resulted from metal/dental implants (10.5%), contrast in central veins (7.7%) and the shoulder region (4.9%). CONCLUSION Single rotation computed tomography angiography of the neck incorporated into cerebral computed tomography perfusion with single contrast medium administration revealed adequate image quality for further decision-making in our patient sample. The main drawbacks were inadequate coverage of supra-aortic arteries and possible delay in timing of the joggle.
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Affiliation(s)
- Siong Chuong Wong
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Klagenfurt am Wörthersee, Austria
| | - Klaus A Hausegger
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Klagenfurt am Wörthersee, Austria
| | - Luca De Paoli
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Klagenfurt am Wörthersee, Austria
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8
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Copelan AZ, Smith ER, Drocton GT, Narsinh KH, Murph D, Khangura RS, Hartley ZJ, Abla AA, Dillon WP, Dowd CF, Higashida RT, Halbach VV, Hetts SW, Cooke DL, Keenan K, Nelson J, Mccoy D, Ciano M, Amans MR. Recent Administration of Iodinated Contrast Renders Core Infarct Estimation Inaccurate Using RAPID Software. AJNR Am J Neuroradiol 2020; 41:2235-2242. [PMID: 33214184 DOI: 10.3174/ajnr.a6908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Automated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast. MATERIALS AND METHODS We reviewed a prospective, single-center data base of 271 consecutive patients who underwent CTA ± CTP for acute ischemic stroke from May 2018 through January 2019. Patients with emergent large-vessel occlusion confirmed by CTA in the extended window (>6 hours since last known well) and CTP with RAPID postprocessing were included. Two blinded raters independently assessed CT ASPECTS on NCCT performed at the time of CTP. RAPID software used relative cerebral blood flow of <30% as a surrogate for irreversible core infarct. Patients were dichotomized on the basis of receiving recent IV iodinated contrast (<8 hours before CTP) for a separate imaging study. RESULTS The recent IV contrast and contrast-naïve cohorts comprised 23 and 15 patients, respectively. Multivariate linear regression analysis demonstrated that recent IV contrast administration was independently associated with a decrease in the RAPID core infarct estimate (proportional increase = 0.34; 95% CI, 0.12-0.96; P = .04). CONCLUSIONS Patients who received IV iodinated contrast in proximity (<8 hours) to CTA/CTP as part of a separate imaging study had a much higher likelihood of core infarct underestimation with RAPID compared with contrast-naïve patients. Over-reliance on RAPID postprocessing for treatment disposition of patients with extended window emergent large-vessel occlusion should be avoided, particularly with recent IV contrast administration.
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Affiliation(s)
- A Z Copelan
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - E R Smith
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.).,Department of Radiology (E.R.S.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - G T Drocton
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - K H Narsinh
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D Murph
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - R S Khangura
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - Z J Hartley
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - A A Abla
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.).,Neurosurgery (A.A.A.), University of California, San Francisco, San Francisco, California
| | - W P Dillon
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - C F Dowd
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - R T Higashida
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - V V Halbach
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - S W Hetts
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D L Cooke
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - K Keenan
- Department of Neurology (K.K.), University of California Davis, Sacramento, California
| | - J Nelson
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D Mccoy
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - M Ciano
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - M R Amans
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
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9
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Lee SK, Jang Y, Jung JW, Je H, Choi J. Comparison of Renal Blood Flow Using Maximum Slope-Based Computed Tomography Perfusion and Ultrasound Flow Probe in Healthy Dogs. Front Vet Sci 2020; 7:541747. [PMID: 33195514 PMCID: PMC7581705 DOI: 10.3389/fvets.2020.541747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/04/2020] [Indexed: 11/15/2022] Open
Abstract
Computed tomography (CT) perfusion can analyze tissue perfusion and quantitative parameters, including blood flow, blood volume, and transit time. CT perfusion has been used for evaluating split renal function. However, its applicability in veterinary medicine was not validated. This study aimed to evaluate the correlation of renal blood flow (RBF) derived by maximum slope-based CT perfusion and an ultrasonic flow probe and assess the effect of the presence of a pre-existing contrast medium on CT perfusion in the kidneys. In five healthy purpose-bred beagles, CT perfusion was performed at the level of the left renal hila after injection of 1 mg/kg iohexol, during measuring RBF with an ultrasonic flow probe placed on the left renal artery. After post-contrast CT scan with injection of 2 mg/kg iohexol, CT perfusion scan was repeated with the same protocol used in the first perfusion study. The CT perfusion derived RBF was analyzed based on the maximum slope and was compared with the true RBF obtained using an ultrasonic flow probe. Results indicated that CT perfusion derived RBF was significantly correlated with true RBF, although CT perfusion derived RBF did not match the absolute value of the true RBF. It was correlated with the true RBF, even in the presence of a pre-existing contrast medium in the kidney. CT perfusion can estimate the change in individual renal perfusion non-invasively, and this method can be used supplementary to the conventional CT protocol in clinic.
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Affiliation(s)
- Sang-Kwon Lee
- Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Youjung Jang
- Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Jin-Woo Jung
- Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Hyejin Je
- Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
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10
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Mayoral Campos V, Guirola Órtiz JA, Tejero Juste C, Gimeno Peribáñez MJ, Serrano C, Pérez Lázaro C, de Blas Giral I, de Gregorio Ariza MÁ. Carotid artery stenting in a single center, single operator, single type of device and 15 years of follow-up. CVIR Endovasc 2018; 1:3. [PMID: 30652136 PMCID: PMC6319529 DOI: 10.1186/s42155-018-0008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background Revascularization with carotid stent (CAS) is considered the therapeutic alternative to endarterectomy (CEA). However, its role compared to CEA remains questioned, mainly due of the heterogeneity of long-term results. The objective of this study was to report the efficacy and durability of CAS in terms of stroke prevention in a "real world experience". Method This was a single-center retrospective analysis of 344 patients treated with CAS between January 2001 and December 2015.The primary outcome of the trial was stroke, myocardial infarction, or death during a periprocedural period or any stroke event over a 15-year follow-up. The secondary aim was to identify risk factors for 30-day complications, long-term neurological complications, and intra-stent restenosis. Results The primary composite end point (any stroke, myocardial infarction, or death during the periprocedural period) was 2.3%. The use of an EPD was protective against major complications.Long-term follow-up was achieved in 294 patients (85,5%) with a median of 50 months (range 0-155 months). Fifty-six (16,3%) died within this period, most commonly of nonvascular causes (4 patients had stroke-related deaths). During the follow-up period, 8 strokes and 3 TIAs were diagnosed (3.2%).ISR determined by sequential ultrasound was assessed in 4.4% of the patients and remained asymptomatic in all but 2 patients (0.6%). All patients with restenosis underwent revascularization with balloon angioplasty. Conclusion The long-term follow-up results of our study validate CAS as a safe and durable procedure with which to prevent ipsilateral stroke, with an acceptable rate of restenosis, recurrence and mortality.
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Affiliation(s)
- Victoria Mayoral Campos
- 1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain.,2Servicio de Radiología intervencionista, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain
| | - José Andrés Guirola Órtiz
- 1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain.,2Servicio de Radiología intervencionista, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Carlos Tejero Juste
- 3Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - María José Gimeno Peribáñez
- 1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain.,2Servicio de Radiología intervencionista, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Carolina Serrano
- 1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain
| | - Cristina Pérez Lázaro
- 3Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Miguel Ángel de Gregorio Ariza
- 1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain.,2Servicio de Radiología intervencionista, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain
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11
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Garcia M, Okell TW, Gloor M, Chappell MA, Jezzard P, Bieri O, Byrne JV. Feasibility of Flat Panel Detector CT in Perfusion Assessment of Brain Arteriovenous Malformations: Initial Clinical Experience. AJNR Am J Neuroradiol 2017; 38:735-739. [PMID: 28209577 DOI: 10.3174/ajnr.a5091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/01/2016] [Indexed: 11/07/2022]
Abstract
The different results from flat panel detector CT in various pathologies have provoked some discussion. Our aim was to assess the role of flat panel detector CT in brain arteriovenous malformations, which has not yet been assessed. Five patients with brain arteriovenous malformations were studied with flat panel detector CT, DSC-MR imaging, and vessel-encoded pseudocontinuous arterial spin-labeling. In glomerular brain arteriovenous malformations, perfusion was highest next to the brain arteriovenous malformation with decreasing values with increasing distance from the lesion. An inverse tendency was observed in the proliferative brain arteriovenous malformation. Flat panel detector CT, originally thought to measure blood volume, correlated more closely with arterial spin-labeling-CBF and DSC-CBF than with DSC-CBV. We conclude that flat panel detector CT perfusion depends on the time point chosen for data collection, which is triggered too early in these patients (ie, when contrast agent appears in the superior sagittal sinus after rapid shunting through the brain arteriovenous malformation). This finding, in combination with high data variability, makes flat panel detector CT inappropriate for perfusion assessment in brain arteriovenous malformations.
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Affiliation(s)
- M Garcia
- From the Division of Diagnostic and Interventional Neuroradiology (M. Garcia) .,Nuffield Department of Surgical Sciences and Department of Neuroradiology (M. Garcia, J.V.B.)
| | - T W Okell
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences
| | - M Gloor
- Division of Radiological Physics (M. Gloor, O.B.), Department of Radiology Clinic for Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - M A Chappell
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences.,Institute of Biomedical Engineering (M.A.C.), Department of Engineering, University of Oxford, Oxford, United Kingdom
| | - P Jezzard
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences
| | - O Bieri
- Division of Radiological Physics (M. Gloor, O.B.), Department of Radiology Clinic for Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - J V Byrne
- Nuffield Department of Surgical Sciences and Department of Neuroradiology (M. Garcia, J.V.B.)
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12
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Kamran M, Downer J, Corkill R, Byrne JV. Non-invasive assessment of vasospasm following aneurysmal SAH using C-arm FDCT parenchymal blood volume measurement in the neuro-interventional suite: Technical feasibility. Interv Neuroradiol 2015; 21:479-89. [PMID: 26017197 DOI: 10.1177/1591019915582376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cerebral vasospasm is the leading cause of morbidity and mortality in patients with aneurysmal subarachnoid haemorrhage (SAH) surviving the initial ictus. Commonly used techniques for vasospasm assessment are digital subtraction angiography and transcranial Doppler sonography. These techniques can reliably identify only the major vessel spasm and fail to estimate its haemodynamic significance. To overcome these issues and to enable comprehensive non-invasive assessment of vasospasm inside the interventional suite, a novel protocol involving measurement of parenchymal blood volume (PBV) using C-arm flat detector computed tomography (FDCT) was implemented. MATERIALS AND METHODS Patients from the neuro-intensive treatment unit (ITU) with suspected vasospasm following aneurysmal SAH were scanned with a biplane C-arm angiography system using an intravenous contrast injection protocol. The PBV maps were generated using prototype software. Contemporaneous clinically indicated MR scan including the diffusion- and perfusion-weighted sequences was performed. C-arm PBV maps were compared against the MR perfusion maps. RESULTS Distribution of haemodynamic impairment on C-arm PBV maps closely matched the pattern of abnormality on MR perfusion maps. On visual comparison between the two techniques, the extent of abnormality indicated PBV to be both cerebral blood flow and cerebral blood volume weighted. CONCLUSION C-arm FDCT PBV measurements allow an objective assessment of the severity and localisation of cerebral hypoperfusion resulting from vasospasm. The technique has proved feasible and useful in very sick patients after aneurysmal SAH. The promise shown in this early study indicates that it deserves further evaluation both for post-SAH vasospasm and in other relevant clinical settings.
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Affiliation(s)
- Mudassar Kamran
- Oxford Neurovascular and Neuroradiology Research Unit, John Radcliffe Hospital, UK
| | - Jonathan Downer
- Department of Neuroradiology, Oxford Neurovascular and Neuroradiology Research Unit, John Radcliffe Hospital, UK
| | - Rufus Corkill
- Department of Neuroradiology, Oxford Neurovascular and Neuroradiology Research Unit, John Radcliffe Hospital, UK
| | - James V Byrne
- Oxford Neurovascular and Neuroradiology Research Unit, John Radcliffe Hospital, UK
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13
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[Vascular assessment in stroke codes: role of computed tomography angiography]. RADIOLOGIA 2014; 57:156-66. [PMID: 25060835 DOI: 10.1016/j.rx.2013.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 10/05/2013] [Accepted: 11/18/2013] [Indexed: 11/22/2022]
Abstract
Advances in imaging studies for acute ischemic stroke are largely due to the development of new efficacious treatments carried out in the acute phase. Together with computed tomography (CT) perfusion studies, CT angiography facilitates the selection of patients who are likely to benefit from appropriate early treatment. CT angiography plays an important role in the workup for acute ischemic stroke because it makes it possible to confirm vascular occlusion, assess the collateral circulation, and obtain an arterial map that is very useful for planning endovascular treatment. In this review about CT angiography, we discuss the main technical characteristics, emphasizing the usefulness of the technique in making the right diagnosis and improving treatment strategies.
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14
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Johnson JM, Reed MS, Burbank HN, Filippi CG. Quality of extracranial carotid evaluation with 256-section CT. AJNR Am J Neuroradiol 2013; 34:1626-31. [PMID: 23471025 DOI: 10.3174/ajnr.a3433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE To date, no systematic evaluation of image quality has been performed on the 256-section multidetector CT scanner for extracranial carotid evaluations. We evaluated image quality, patient dose, and examination time and compared these parameters with a 64-section multidetector CT. MATERIALS AND METHODS We reviewed extracranial CTA scans obtained on a 256-detector CT scanner in 50 consecutive patients. Image quality was analyzed for artifacts and vessel contrast opacification from the aortic arch to the skull base, dose to patient, and scan time. Results were compared with a control group of 50 patients imaged on a 64-section CT scanner. A Fisher exact test was used to analyze both groups with respect to vessel contrast opacification and presence of artifacts, and a Student t test was used to assess differences in patient dose between the 2 groups. RESULTS Quantitative and qualitative evaluations revealed >95% acceptable vessel opacification at all levels measured on the 256-section scanner. Scan time was improved (4 seconds on 256-channel). There were fewer artifacts related to metallic streak on the 256-channel CTA study, and DLP was lower on the 256-channel CTA (113.9 versus 159.8 mGy). CONCLUSIONS The 256-channel CTA imaging protocol for carotid arteries yielded similar vessel contrast opacification compared with the 64-channel CTA but with fewer metallic artifacts, a modest decrease in scan time, similar image quality, and a statistically significant reduction in radiation dose of 10%.
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Affiliation(s)
- J M Johnson
- Section of Neuroradiology, Department of Radiology, Fletcher Allen Health Care, Burlington, VT, USA.
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15
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Abstract
OBJECTIVE/BACKGROUND We describe the internal cerebral vein (ICV) sign, which is a hypo-opacification of the ICV on computed tomogram angiography (CTA) as a new marker of increased cerebral blood transit-time in ipsilateral internal carotid artery occlusions (ICAO). METHODS A retrospective analysis of 153 patients with acute unilateral M1 middle cerebral artery (MCA) occlusions ± ICAOs was performed. The degree of contrast opacification of the ICV on the ipsilesional side was compared to that of the unaffected side. RESULTS Of 153 patients in our study, 135 had M1 MCA occlusions ± intra-cranial ICAO (M1±iICAO) and 18 had isolated extracranial ICAO (eICAO). In the patients with proximal M1±iICAO, 57/65 (87.1%) showed the ICV sign. Of the 8 patients without the ICV sign in this group, 6 had prominent lenticulostriate arteries arising from the non-occluded M1 segment, 1 had a recurrent artery of Huebner, and 1 had filling of distal ICA/M1 segment through prominent Circle of Willis collaterals. For the 70 patients with isolated distal M1±iICAO, 7/70 (10%) showed the ICV sign, with all 7 showing occluded lenticulostriate arteries. Of the patients with eICAO, 8/18 showed the ICV sign, all 8 with the ICV sign had poor Circle of Willis collaterals. CONCLUSIONS The ICV sign correlates well with presence of proximal M1±iICAO in patients with either occluded lenticulostriate arteries or poor Circle of Willis collaterals. In patients with eICAO, the sign correlates with reduced Circle of Willis collaterals and may be a marker of increased ipsilateral cerebral blood transit time.
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16
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Optimal sequence timing of CT angiography and perfusion CT in patients with stroke. Eur J Radiol 2013; 82:e286-9. [DOI: 10.1016/j.ejrad.2013.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 11/19/2022]
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17
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Mousa AE, Elrakhawy MM, Zaher AA. Multimodal CT assessment of acute ischemic stroke. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hurley MC, Soltanolkotabi M, Ansari S. Neuroimaging in acute stroke: choosing the right patient for neurointervention. Tech Vasc Interv Radiol 2012; 15:19-32. [PMID: 22464299 DOI: 10.1053/j.tvir.2011.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the non-contrast computed tomography head continues as the sole mandatory imaging technique before intravenous thrombolysis, the increased availability of advanced infarct/penumbral imaging techniques and confidence in their use have led many to adopt them into routine practice--most particularly before intra-arterial interventions. Computed tomography versus magnetic resonance-based routes to imaging the cerebral vasculature, cell death, and parenchymal perfusion have differing advantages in terms of speed, availability, exposures to contrast and radiation, sensitivity, and resolution. Continued refinement and future developments, such as the ability to quantitate perfusion, promise to lead to tailored treatment protocols that respect the individual variations in anatomy, physiology, and pathology. This should lead both to an extension of treatment to patients currently excluded by rigid time windows and the avoidance of futile therapies and their associated morbidities.
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Affiliation(s)
- Michael C Hurley
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Fahmi F, Marquering HA, Streekstra GJ, Beenen LFM, Velthuis BK, VanBavel E, Majoie CB. Differences in CT perfusion summary maps for patients with acute ischemic stroke generated by 2 software packages. AJNR Am J Neuroradiol 2012; 33:2074-80. [PMID: 22555577 DOI: 10.3174/ajnr.a3110] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although CT perfusion is a promising tool to support treatment decisions for patients with acute ischemic stroke, it still lacks a standardized method for CTP analysis. The purpose of this study was to assess the variability of the area of infarct core and penumbra as presented in summary maps produced by 2 different software packages. MATERIALS AND METHODS Forty-one CTP image datasets of 26 consecutive patients who presented with acute ischemic stroke were retrospectively evaluated. Identical image datasets were analyzed by using 2 different commercially available CTP analysis software packages, each representing a mainstream of widely used algorithms: delay-sensitive and delay-insensitive. Bland-Altman analyses were performed to evaluate the level of agreement between the 2 methods in determining the area of infarct core and penumbra area in the summary maps. RESULTS There was a statistically significant difference in infarct core area (-23.6 ± 25.6 cm(2)) and penumbra area (15.8 ± 25.3 cm(2)) between the 2 software packages. For all the areas presented in the summary maps, the Bland-Altman interval limit of agreement was larger than 100 cm(2). CONCLUSIONS The infarct core and penumbra area of CTP summary maps generated by 2 commonly used software packages were significantly different, emphasizing the need for standardization and validation of CTP analysis before it can be applied to patient management in clinical practice.
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Affiliation(s)
- F Fahmi
- Departments of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands.
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