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McDougall CC, Chan L, Sachan S, Guo J, Sah RG, Menon BK, Demchuk AM, Hill MD, Forkert ND, d'Esterre CD, Barber PA. Dynamic CTA-Derived Perfusion Maps Predict Final Infarct Volume: The Simple Perfusion Reconstruction Algorithm. AJNR Am J Neuroradiol 2020; 41:2034-2040. [PMID: 33004342 DOI: 10.3174/ajnr.a6783] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Infarct core volume measurement using CTP (CT perfusion) is a mainstay paradigm for stroke treatment decision-making. Yet, there are several downfalls with cine CTP technology that can be overcome by adopting the simple perfusion reconstruction algorithm (SPIRAL) derived from multiphase CTA. We compare SPIRAL with CTP parameters for the prediction of 24-hour infarction. MATERIALS AND METHODS Seventy-two patients had admission NCCT, multiphase CTA, CTP, and 24-hour DWI. All patients had successful/quality reperfusion. Patient-level and cohort-level receiver operator characteristic curves were generated to determine accuracy. A 10-fold cross-validation was performed on the cohort-level data. Infarct core volume was compared for SPIRAL, CTP-time-to-maximum, and final DWI by Bland-Altman analysis. RESULTS When we compared the accuracy in patients with early and late reperfusion for cortical GM and WM, there was no significant difference at the patient level (0.83 versus 0.84, respectively), cohort level (0.82 versus 0.81, respectively), or the cross-validation (0.77 versus 0.74, respectively). In the patient-level receiver operating characteristic analysis, the SPIRAL map had a slightly higher, though nonsignificant (P < .05), average receiver operating characteristic area under the curve (cortical GM/WM, r = 0.82; basal ganglia = 0.79, respectively) than both the CTP-time-to-maximum (cortical GM/WM = 0.82; basal ganglia = 0.78, respectively) and CTP-CBF (cortical GM/WM = 0.74; basal ganglia = 0.78, respectively) parameter maps. The same relationship was observed at the cohort level. The Bland-Altman plot limits of agreement for SPIRAL and time-to-maximum infarct volume were similar compared with 24-hour DWI. CONCLUSIONS We have shown that perfusion maps generated from a temporally sampled helical CTA are an accurate surrogate for infarct core.
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Affiliation(s)
- C C McDougall
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Department of Radiology (C.C.M., B.K.M., N.D.F., C.D.d.E., P.A.B.).,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - L Chan
- Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.)
| | - S Sachan
- Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.)
| | - J Guo
- Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.)
| | - R G Sah
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - B K Menon
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Department of Radiology (C.C.M., B.K.M., N.D.F., C.D.d.E., P.A.B.).,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - A M Demchuk
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - M D Hill
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - N D Forkert
- Department of Radiology (C.C.M., B.K.M., N.D.F., C.D.d.E., P.A.B.).,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Alberta Children's Hospital Research Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - C D d'Esterre
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program.,Department of Radiology (C.C.M., B.K.M., N.D.F., C.D.d.E., P.A.B.).,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Department of Clinical Neurosciences (C.C.M., L.C., S.S., J.G., R.G.S., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - P A Barber
- From the Department of Clinical Neurosciences (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d., P.A.B.), Calgary Stroke Program .,Department of Radiology (C.C.M., B.K.M., N.D.F., C.D.d.E., P.A.B.).,Hotchkiss Brain Institute (C.C.M., B.K.M., A.M.D., M.D.H., N.D.F., C.C.d.E., P.A.B.).,Seaman Family Centre (C.C.M., R.G.S., B.K.M., A.M.D., M.D.H., C.D.d.E., P.A.B.), Foothills Medical Centre, Calgary, Alberta, Canada
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d’Esterre CD, Boesen ME, Ahn SH, Pordeli P, Najm M, Minhas P, Davari P, Fainardi E, Rubiera M, Khaw AV, Zini A, Frayne R, Hill MD, Demchuk AM, Sajobi TT, Forkert ND, Goyal M, Lee TY, Menon BK. Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic Stroke. Stroke 2015; 46:3390-7. [DOI: 10.1161/strokeaha.115.009250] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher D. d’Esterre
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mari E. Boesen
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Seong Hwan Ahn
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Pooneh Pordeli
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mohamed Najm
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Priyanka Minhas
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Paniz Davari
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Enrico Fainardi
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Marta Rubiera
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Alexander V. Khaw
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Andrea Zini
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Richard Frayne
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Michael D. Hill
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Andrew M. Demchuk
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Tolulope T. Sajobi
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Nils D. Forkert
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mayank Goyal
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Ting Y. Lee
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Bijoy K. Menon
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
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