Is the optimal Tmax threshold identifying perfusion deficit volumes variable across MR perfusion software packages? A pilot study

Bani-Sadr, Alexandre; Trintignac, Mathilde; Mechtouff, Laura; Hermier, M.; Cappucci, Matteo; Améli, Roxana; Bourguignon, Charles de; Derex, Laurent; Cho, Tae-Hee; Nighoghossian, Norbert; Berthezène, Yves

doi:10.1007/s10334-023-01068-0

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…It can accurately detect the penumbra ( 7 ). Studies have reported that Tmax strata proportions can predict neurological deterioration in patients with ischemic stroke ( 8 , 9 ). However, few studies have reported the related influencing factors of volume of Tmax>6 s.…”

Section: Introductionmentioning

confidence: 99%

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Zhou,

Jin,

Liu

et al. 2024

Front. Neurol.

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PurposeTo explore the relationship between obstructive sleep apnea (OSA) and hypoperfusion during ultra-early acute cerebral infarction.Patients and methodsData were retrospectively collected from patients admitted to our hospital with acute cerebral infarction between January 2020 and January 2022, who underwent comprehensive whole-brain computed tomography perfusion imaging and angiography examinations within 6 h of onset. The F-stroke software automatically assessed and obtained relevant data (Tmax). The patients underwent an initial screening for sleep apnea. Based on their Apnea-Hypopnea Index (AHI), patients were categorized into an AHI ≤15 (n = 22) or AHI >15 (n = 25) group. The pairwise difference of the time-to-maximum of the residue function (Tmax) > 6 s volume was compared, and the correlation between AHI, mean pulse oxygen saturation (SpO2), oxygen desaturation index (ODI), percentage of time with oxygen saturation < 90% (T90%), and the Tmax >6 s volume was analyzed.ResultsThe Tmax >6 s volume in the AHI > 15 group was significantly larger than that in the AHI ≤ 15 group [109 (62–157) vs. 59 (21–106) mL, p = 0.013]. Spearman’s correlation analysis revealed Tmax >6 s volume was significantly correlated with AHI, mean SpO2, ODI, and T90% in the AHI > 15 group, however, no significant correlations were observed in the AHI ≤ 15 group. Controlling for the site of occlusion and Multiphase CT angiography (mCTA) score, AHI (β = 0.919, p < 0.001), mean SpO2 (β = −0.460, p = 0.031), ODI (β = 0.467, p = 0.032), and T90% (β =0.478, p = 0.026) remained associated with early hypoperfusion in the AHI > 15 group.ConclusionIn patients with acute cerebral infarction and AHI > 15, AHI, mean SpO2, ODI and T90% were associated with early hypoperfusion. However, no such relationship exists among patients with AHI ≤ 15.

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Section: Introductionmentioning

confidence: 99%

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Zhou,

Jin,

Liu

et al. 2024

Front. Neurol.

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“…Several software enable the generation of maps outlining the estimated core and penumbral brain regions using thresholded maps on MRI or CT-perfusion, allowing their use for urgent therapeutic decisions in clinical practice. However, substantial differences in core or penumbra volumes estimation across software have been pointed using either CT or MRI, highlighting the need for technique standardization in the future [21][22][23][24]. Second, the post-EVT reperfusion of even small penumbra volumes may still have clinical relevance depending on the "eloquence" of the affected brain area.…”

Section: Introductionmentioning

confidence: 99%

Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion?

Seners,

Baron,

Olivot

et al. 2023

Current Opinion in Neurology

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Purpose of review In this review, we summarize current evidence regarding potential benefits and limitations of using perfusion imaging to estimate presence and extent of irreversibly injured ischemic brain tissue (‘core’) and severely ischemic yet salvageable tissue (‘penumbra’) in acute stroke patients with large vessel occlusion (LVO). Recent findings Core and penumbra volumes are strong prognostic biomarkers in LVO patients. Greater benefits of both intravenous thrombolysis and endovascular therapy (EVT) are observed in patients with small core and large penumbra volumes. However, some current definitions of clinically relevant penumbra may be too restrictive and exclude patients who may benefit from reperfusion therapies. Alongside other clinical and radiological factors, penumbral imaging may enhance the discussion regarding the benefit/risk ratio of EVT in common clinical situations, such as patients with large core – for whom EVT's benefit is established but associated with a high rate of severe disability –, or patients with mild symptoms or medium vessel occlusions – for whom EVT's benefit is currently unknown. Beyond penumbral evaluation, perfusion imaging is clinically relevant for optimizing patient's selection for neuroprotection trials. Summary In an emerging era of precision medicine, perfusion imaging is a valuable tool in LVO-related acute stroke.

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The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke

Yi,

Ki,

Jeon

et al. 2023

Eur Radiol

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Objectives This study evaluated the collateral map’s ability to predict lesion growth and penumbra after acute anterior circulation ischemic strokes. Methods This was a retrospective analysis of selected data from a prospectively collected database. The lesion growth ratio was the ratio of the follow-up lesion volume to the baseline lesion volume on diffusion-weighted imaging (DWI). The time-to-maximum (Tmax)/DWI ratio was the ratio of the baseline Tmax > 6 s volume to the baseline lesion volume. The collateral ratio was the ratio of the hypoperfused lesion volume of the phase_FU (phase with the hypoperfused lesions most approximate to the follow-up DWI lesion) to the hypoperfused lesion volume of the phase_baseline of the collateral map. Multiple logistic regression analyses were conducted to identify independent predictors of lesion growth. The concordance correlation coefficients of Tmax/DWI ratio and collateral ratio for lesion growth ratio were analyzed. Results Fifty-two patients, including twenty-six males (mean age, 74 years), were included. Intermediate (OR, 1234.5; p < 0.001) and poor collateral perfusion grades (OR, 664.7; p = 0.006) were independently associated with lesion growth. Phase_FUs were immediately preceded phases of the phase_baselines in intermediate or poor collateral perfusion grades. The concordance correlation coefficients of the Tmax/DWI ratio and collateral ratio for the lesion growth ratio were 0.28 (95% CI, 0.17–0.38) and 0.88 (95% CI, 0.82–0.92), respectively. Conclusion Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Further studies are needed to generalize the findings of this study. Clinical relevance statement Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Key Points • Cell viability in cerebral ischemia due to proximal arterial steno-occlusion mainly depends on the collateral circulation. • The collateral map shows salvageable brain extent, which can survive by recanalization treatments after acute anterior circulation ischemic stroke. • Precise estimation of salvageable brain makes it possible to make patient-specific treatment decision.

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Is the optimal Tmax threshold identifying perfusion deficit volumes variable across MR perfusion software packages? A pilot study

Cited by 3 publications

References 31 publications

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion?

The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke

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