Computed Tomography Perfusion Data for Acute Ischemic Stroke Evaluation Using Rapid Software: Pitfalls of Automated Postprocessing

Kauw, Frans; Heit, Jeremy J; Martin, Benjamin; Ommen, Fasco van; Kappelle, L. Jaap; Velthuis, Birgitta K.; Jong, Hugo W. A. M. de; Dankbaar, Jan Willem; Wintermark, Max

doi:10.1097/rct.0000000000000946

Cited by 23 publications

(39 citation statements)

References 8 publications

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“…The main reason for the higher failure rate of CTP might be that it was di cult for the patients to remain stationary during the longer scan time than CTA. In consistent with the prior study, we found that baseline NIHSS was the risk factor that signi cantly associated with CTP failure [9]. Patients with higher baseline NIHSS would be neurologically more severe, more restless, and more likely to be mobile during the scanning process.…”

Section: Discussionsupporting

confidence: 90%

“…Besides longer time consumption, CTP also showed higher failure rate than CTA in our study. Kauw et al reported a CTP failure rate of 11%, and they found that motion was the leading cause, followed by streak artifacts and poor contrast bolus arrival, which was in line with our study [9]. The main reason for the higher failure rate of CTP might be that it was di cult for the patients to remain stationary during the longer scan time than CTA.…”

Section: Discussionsupporting

confidence: 90%

“…Previous studies reported that CTP needed more time to acquire, process and interpret and hold high rate of post-processing failure. These disadvantages might contribute to the recommendation not to use CTP for imaging assessment for patients within the time window [8,9]. However, Olivot et al recently reported that 29 percent of AIS patients with onset time less than 6 hours had no target mismatch.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

Chu¹,

Ma²,

Xu³

et al. 2021

Preprint

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Background: Our study aimed to compare the time usage and success rate between CTA- and CTP- based assessment strategy, and to clarify the risk factors associated with CTP scan failure. Methods: Clinical and radiological data of 437 consecutive AIS patients who underwent multiphase CTA or CTP for pre-treatment evaluation were retrospectively enrolled (CTA group, n=302; CTP group, n=135). Time usage and success rate of CTA and CTP were compared using Mann-Whitney U test and Chi-Squared Test. Univariate analysis and receiver operating curve analysis were used to clarify the risk factors and their values for predicting CTP scan failure.Results: Time usage of CTP scan and reconstruction was significantly longer than that of CTA [775sec vs 263.5sec, P<0.001]. CTP scan showed significantly higher failure rate than CTA (11% vs 1%, P<0.001). Severe motion was the most common cause of CTP failure (n=12, 80%). Baseline National Institute of Health Stroke Scale (NIHSS) score in CTP failure group was significantly higher than that in CTP success group [17 vs 13, P=0.007]. Baseline NIHSS score of 11 was the optimal threshold to predict CTP failure with an area under the curve of 0.771, sensitivity of 86.7% and specificity of 45.0%.Conclusions: CTP-based strategy showed longer time consumption and higher failure rate than CTA-based strategy. High baseline NIHSS score was significantly associated with CTP scan failure in AIS patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

Chu¹,

Ma²,

Xu³

et al. 2021

Preprint

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“…For these reasons, the multimodal evaluation of the whole neuroradiological examination (NCCT, all qualitative and quantitative CTP maps) must be underlined [46].…”

Section: Resultsmentioning

confidence: 99%

Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

et al. 2020

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Purpose To compare the diagnostic accuracy (ACC) in the detection of acute posterior circulation strokes between qualitative evaluation of software-generated colour maps and automatic assessment of CT perfusion (CTP) parameters. Methods Were retrospectively collected 50 patients suspected of acute posterior circulation stroke who underwent to CTP (GE "Lightspeed", 64 slices) within 24 h after symptom onset between January 2016 and December 2018. The Posterior circulation-Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was used for quantifying the extent of ischaemic areas on non-contrast (NC)CT and colour-coded maps generated by CTP4 (GE) and RAPID (iSchemia View) software. Final pc-ASPECTS was calculated on follow-up NCCT and/or MRI (Philips Intera 3.0 T or Philips Achieva Ingenia 1.5 T). RAPID software also elaborated automatic quantitative mismatch maps. Results By qualitative evaluation of colour-coded maps, MTT-CTP4D and Tmax-RAPID showed the highest sensitivity (SE) (88.6% and 90.9%, respectively) and ACC (84% and 88%, respectively) compared with the other perfusion parameters (CBV, CBF). Baseline NCCT and CBF provided by RAPID quantitative perfusion mismatch maps had the lowest SE (29.6% and 6.8%, respectively) and ACC (38% and 18%, respectively). CBF and Tmax assessment provided by quantitative RAPID perfusion mismatch maps showed significant lower SE and ACC than qualitative evaluation. No significant differences were found between the pc-ASPECTSs assessed on colour-coded MTT and Tmax maps neither between the scores assessed on colourcoded CBV-CTP4D and CBF-RAPID maps. Conclusion Qualitative analysis of colour-coded maps resulted more sensitive and accurate in the detection of ischaemic changes than automatic quantitative analysis.

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“…Eine Herausforderung für die Umsetzung der Studienergebnisse in die klinische Praxis stellt die automatisierte Bildverarbeitung dar. Die in EXTEND, DAWN und DEFUSE-3 verwendete RAPID-Software steht als kommerzielles Produkt nicht allen Krankenhäusern zur Verfügung und liefert in bis zu 11 % der Fälle fehlerhafte Segmentierungen von Infarktkern und Penumbra[30]. Die Auswertung nationaler und internationaler Schlaganfallregister wird Auskunft geben, in welchem Ausmaße von den strengen Studienkriterien in der Praxis abgewichen werden kann.…”

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Therapie des akuten ischämischen Schlaganfalls

Schlemm¹,

Kestner²,

Bohmann³

et al. 2020

Nervenheilkunde

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ZUSAMMENFASSUNGDie Behandlungsmöglichkeiten des akuten ischämischen Schlaganfalls haben sich durch Weiterentwicklung bewährter und Erprobung neuer Therapieansätze in den letzten Jahren verbessert. Durch den Einsatz der erweiterten Akutbildgebung mittels multimodaler Computer- oder Magnetresonanztomografie konnte der Zugang zu Thrombolyse und Thrombektomie auch für ausgewählte Patienten mit unbekanntem oder bis zu 9 bzw. 24 h zurückliegendem Beginn der akuten Schlaganfallsymptomatik ermöglicht werden. Ergänzend zu diesen rekanalisierenden Akuttherapien zeigen adjuvante neuroprotektive und immunmodulatorische Behandlungsansätze vielversprechende Ergebnisse. Schließlich gewinnen eine verbesserte Zusammenarbeit der an der Schlaganfallversorgung beteiligten Fachdisziplinen und die Optimierung logistischer Prozesse an Bedeutung, um den zeitabhängigen Nutzen der Akuttherapie individuell zu maximieren. Der vorliegende Artikel fasst wesentliche aktuelle Studienergebnisse zur Akuttherapie des ischämischen Schlaganfalls zusammen und gibt Empfehlungen für eine evidenzbasierte Bildgebung als Grundlage effektiver Reperfusionstherapien.

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Computed Tomography Perfusion Data for Acute Ischemic Stroke Evaluation Using Rapid Software: Pitfalls of Automated Postprocessing

Cited by 23 publications

References 8 publications

Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

Therapie des akuten ischämischen Schlaganfalls

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