Perfusion CT in acute stroke: effectiveness of automatically-generated colour maps

Ukmar, Maja; Degrassi, Ferruccio; Mucelli, R Pozzi; Neri, Francesca; Mucelli, F. Pozzi; Cova, Maria Assunta

doi:10.1259/bjr.20150472

Cited by 10 publications

(15 citation statements)

References 18 publications

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“…As expected, CBF resulted more specific than MTT for stroke because MTT values can be prolonged in transitory ischaemic attack as well as stroke [19]. As previously described in literature, we found that qualitatively evaluated MTT and Tmax 1 had low specificity for perfusion deficits [12].…”

Section: Mtt and Tmaxsupporting

confidence: 81%

“…Brain imaging plays a key role in the evaluation of patients suspected of ischaemic stroke allowing to reach a confident diagnosis of infratentorial stroke [ 5 , 12 ]. MRI with DWI represents the diagnostic gold standard for the detection of ischaemic lesions in the PC territories [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A visible qualitative focal reduction in CBF or CBV and a focal increase MTT on colour-coded maps was rated as abnormal and evaluated with pc-ASPECTS. When a perfusion deficit was suspected in the maps, it was compared with the NCCT scan to exclude false positive caused by beam hardening artefacts, chronic infarct or overlapping with liquoral spaces [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Posterior circulation (PC) stroke accounts for 20-25% of ischaemic strokes and is characterised by a wide range of clinical features that make its clinical diagnosis challenging [1][2][3][4][5][6][7][8][9][10][11][12]. In emergency setting, dynamic CT perfusion (CTP) has been introduced as a particularly useful technique after noncontrast CT (NCCT) given its easy application, reproducibility of quantitative assessment, prompt availability, low cost and tolerability [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Mtt and Tmaxsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…The penumbra always surrounds the infarct area (core), where brain tissue is irreversibly affected by ischaemic lesions. Therefore, it is crucial to quickly diagnose the condition using advanced tools of medical imaging, which make it possible not only to visualise the ischaemic region, but also to differentiate the area into the penumbral zone and the core, which is essential for adopting a treatment strategy [3,5]. In clinical practice, CTP also improves diagnostic confidence and is a useful adjunct to clinical assessment and standard imaging [5,6].…”

Section: Introductionmentioning

confidence: 99%

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

Gleń¹,

Chrzan²,

Urbanik³

2019

pjr

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Purpose Assessment of software applications designed for post-processing of CT imaging data and perfusion maps in terms of their ability to consistently define the penumbra and core in an ischemic area. Material and methods This study is based on measurements conducted in a group of 65 patients with neurological symptoms suggestive of ischaemia in the area of the MCA within 12 hours following onset of the first symptoms. Non-contrast and perfusion CT were performed during an emergency duty. The acquired data were processed using various programs to obtain defined ischaemic areas and parameters. Finally, the results obtained were compared to the distribution of penumbra and core within the ischaemic area received from different perfusion mapping programs. Results The programs designed to convert the acquired data and to map the distribution of perfusion were also assessed for their viability in dividing the ischaemic zone into penumbra and core. There was a statistically strong correlation (0.784-0.846) between results obtained by processing of imaging data with two different packages, and then by post-processing with one package, and a poor correlation (0.315-0.554) between results obtained by processing of data with the same package, and post-processing with two different packages designed for measuring penumbra and core areas. Conclusions The results obtained by processing of imaging data with different software applications and by post-processing with one program developed for identifying penumbra and core areas show a strong correlation. However, the results obtained by processing imaging data with the same software application and by post-processing with different programs measuring penumbra and core areas reveal poor correlation.

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Advances in cerebral perfusion imaging techniques in acute ischemic stroke

Fang

Cheng

et al. 2022

J of Clinical Ultrasound

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The application of cerebral perfusion imaging has demonstrated significant assessment benefits and an ability to establish an appropriate triage of patients with acute ischemic stroke (AIS) and large artery occlusion (LAO) in the extended time window. Computed tomography perfusion (CTP) and magnetic resonance imaging (MRI) are routinely used to determine the ischemic core, as well as the tissue at risk, to aid in therapeutic decision‐making. However, the time required to transport patients to imaging extends the door‐to‐reperfusion time. C‐arm cone‐beam CT (CBCT) is a novel tomography technology that combines 2D radiography and 3D CT imaging based on the digital subtraction angiography platform. In comparison with CT or MRI perfusion techniques, CBCT combined with catheterized angiogram or therapy can serve as a “one‐stop‐shop” for the diagnosis and treatment of AIS, and greatly reduce the door to reperfusion time. Here, we review the current evidence on the efficacy and theoretical basis of CBCT, as well as other perfusion techniques, with the purpose to assist clinicians to establish an effective and repaid workflow for patients with AIS and LAO in clinical practice.

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Perfusion CT in acute stroke: effectiveness of automatically-generated colour maps

Cited by 10 publications

References 18 publications

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

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

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

Advances in cerebral perfusion imaging techniques in acute ischemic stroke

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