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Rau A, Reisert M, Stein T, Mueller-Peltzer K, Rau S, Bamberg F, Taschner CA, Urbach H, Kellner E. Impact of temporal resolution on perfusion metrics, therapy decision, and radiation dose reduction in brain CT perfusion in patients with suspected stroke. Neuroradiology 2024; 66:749-759. [PMID: 38498208 PMCID: PMC11031466 DOI: 10.1007/s00234-024-03335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE CT perfusion of the brain is a powerful tool in stroke imaging, though the radiation dose is rather high. Several strategies for dose reduction have been proposed, including increasing the intervals between the dynamic scans. We determined the impact of temporal resolution on perfusion metrics, therapy decision, and radiation dose reduction in brain CT perfusion from a large dataset of patients with suspected stroke. METHODS We retrospectively included 3555 perfusion scans from our clinical routine dataset. All cases were processed using the perfusion software VEOcore with a standard sampling of 1.5 s, as well as simulated reduced temporal resolution of 3.0, 4.5, and 6.0 s by leaving out respective time points. The resulting perfusion maps and calculated volumes of infarct core and mismatch were compared quantitatively. Finally, hypothetical decisions for mechanical thrombectomy following the DEFUSE-3 criteria were compared. RESULTS The agreement between calculated volumes for core (ICC = 0.99, 0.99, and 0.98) and hypoperfusion (ICC = 0.99, 0.99, and 0.97) was excellent for all temporal sampling schemes. Of the 1226 cases with vascular occlusion, 14 (1%) for 3.0 s sampling, 23 (2%) for 4.5 s sampling, and 63 (5%) for 6.0 s sampling would have been treated differently if the DEFUSE-3 criteria had been applied. Reduction of temporal resolution to 3.0 s, 4.5 s, and 6.0 s reduced the radiation dose by a factor of 2, 3, or 4. CONCLUSION Reducing the temporal sampling of brain perfusion CT has only a minor impact on image quality and treatment decision, but significantly reduces the radiation dose to that of standard non-contrast CT.
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Affiliation(s)
- Alexander Rau
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marco Reisert
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Mueller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Rau
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bushnaq S, Hassan AE, Delora A, Kerro A, Datta A, Ezzeldin R, Ali Z, Anwoju T, Nejad L, Silva R, Abualnadi YD, Khalil ZM, Ezzeldin M. A Comparison of CT Perfusion Output of RapidAI and Viz.ai Software in the Evaluation of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2024:ajnr.A8196. [PMID: 38346817 DOI: 10.3174/ajnr.a8196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND PURPOSE Automated CTP postprocessing packages have been developed for managing acute ischemic stroke. These packages use image processing techniques to identify the ischemic core and penumbra. This study aimed to investigate the agreement of decision-making rules and output derived from RapidAI and Viz.ai software packages in early and late time windows and to identify predictors of inadequate quality CTP studies. MATERIALS AND METHODS One hundred twenty-nine patients with acute ischemic stroke who had CTP performed on presentation were analyzed by RapidAI and Viz.ai. Volumetric outputs were compared between packages by performing Spearman rank-order correlation and Wilcoxon signed-rank tests with subanalysis performed at early (<6 hours) and extended (>6 hours) time windows. The concordance of selecting patients on the basis of DAWN and DEFUSE 3 eligibility criteria was assessed using the McNemar test. RESULTS One hundred eight of 129 patients were found to have adequate-quality studies. Spearman rank-order correlation coefficients were calculated on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio between both software packages with correlation coefficients of 0.82, 0.65, 0.77, 0.78, 0.59, respectively. The Wilcoxon signed-rank test was also performed on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio with P values of .30, .016, <.001, .03, <.001, respectively. In a 1-sided test, CBF <30% was greater in Viz.ai (P < .001). Although this finding resulted in statistically significant differences, it did not cause clinically significant differences when applied to the DAWN and DEFUSE 3 criteria. A lower ejection fraction predicted an inadequate study in both software packages (P = .018; 95% CI, 0.01-0.113) and (P = .024; 95% CI, 0.008-0.109) for RapidAI and Viz.ai, respectively. CONCLUSIONS Penumbra and infarct core predictions between Rapid and Viz.ai correlated but were statistically different and resulted in equivalent triage using DAWN and DEFUSE3 criteria. Viz.ai predicted higher ischemic core volumes than RapidAI. Viz.ai predicted lower combined core and penumbra values than RapidAI at lower volumes and higher estimates than RapidAI at higher volumes. Clinicians should be cautious when using different software packages for clinical decision-making.
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Affiliation(s)
- Saif Bushnaq
- From the Department of Neurology (S.B.), Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ameer E Hassan
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Adam Delora
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Ali Kerro
- Department of Neurology (A.K.), HCA Houston Healthcare Conroe, Conroe, Texas
| | - Anita Datta
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Rime Ezzeldin
- Jordan University of Science and Technology (R.E.), Irbid, Jordan
| | - Zuhair Ali
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Tunmi Anwoju
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Layla Nejad
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Rene Silva
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Yazan Diya Abualnadi
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Zorain Mustafa Khalil
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Mohamad Ezzeldin
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Xu XQ, Cao LL, Ma G, Shen GC, Lu SS, Zhang YX, Zhang Y, Shi HB, Liu S, Wu FY. Potential Approach to Quantifying the Volume of the Ischemic Core in Truncated Computed Tomography Perfusion Scans: A Preliminary Study. J Comput Assist Tomogr 2024; 48:298-302. [PMID: 37757843 DOI: 10.1097/rct.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE This study aimed to provide an alternative approach for quantifying the volume of the ischemic core (IC) if truncation of computed tomography perfusion (CTP) occurs in clinical practice. METHODS Baseline CTP and follow-up diffusion-weighted imaging (DWI) data from 88 patients with stroke were retrospectively collected. CTP source images (CTPSI) from the unenhanced phase to the peak arterial phase (CTPSI-A) or the peak venous phase (CTPSI-V) were collected to simulate the truncation of CTP in the arterial or venous phases, respectively. The volume of IC on CTPSI-A (V CTPSI-A ) or CTPSI-V (V CTPSI-V ) was defined as the volume of the brain tissue with >65% reduction in attenuation compared with that of the normal tissue. The volume of IC on the baseline CTP (V CTP ) was defined as a relative cerebral blood flow of <30% of that in the normal tissue. The volume of the posttreatment infarct on the follow-up DWI (V DWI ) image was manually delineated and calculated. One-way analysis of variance, Bland-Altman plots, and Spearman correlation analyses were used for the statistical analysis. RESULTS V CTPSI-A was significantly higher than V DWI ( P < 0.001); however, no significant difference was observed between V CTP and V DWI ( P = 0.073) or between V CTPSI-V and V DWI ( P > 0.999). The mean differences between V DWI and V CTPSI-V , V DWI and V CTP , and V DWI and V CTPSI-A were 1.70 mL (limits of agreement [LoA], -56.40 to 59.70), 8.30 mL (LoA, -40.70 to 57.30), and -68.10 mL (LoA, -180.90 to 44.70), respectively. Significant correlations were observed between V DWI and V CTP ( r = 0.68, P < 0.001) and between V DWI and V CTPSI-V ( r = 0.39, P < 0.001); however, no significant correlation was observed between V DWI and V CTPSI-A ( r = 0.20, P = 0.068). CONCLUSIONS V CTPSI-V may be a promising method for quantifying the volume of the IC if truncation of CTP occurs.
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Affiliation(s)
- Xiao-Quan Xu
- From the Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | - Lin-Li Cao
- Department of Medical Imaging, Jiangsu Second Hospital of Traditional Chinese Medicine, Nanjing
| | - Gao Ma
- From the Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | - Guang-Chen Shen
- From the Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | - Shan-Shan Lu
- From the Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | | | - Yu Zhang
- Shukun Network Technology, Co, Ltd, Beijing
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- From the Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
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