The Effect of Non-contrast CT Slice Thickness on Thrombus Density and Perviousness Assessment

Tolhuisen, Manon L.; Enthoven, J.J.M.; Santos, Emilie M. M.; Niessen, Wiro J.; Beenen, Ludo F. M.; Dippel, Diederik W.J.; Lugt, Aad van der; Zwam, Wim H van; Roos, Yvo B.W.E.M.; Oostenbrugge, Robert J. van; Majoie, Charles B. L. M.; Marquering, Henk A.

doi:10.1007/978-3-319-67564-0_17

Cited by 4 publications

(7 citation statements)

References 12 publications

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“…Slice thickness differences between NCCT and CTA could affect density measurements due to partial volume effect. 24 Minor coregistration errors could minimally offset marker placement in NCCT or CTA. Random (Gaussian) noise could cause affect HU values on either NCCT or CTA.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative methods like qualitative assessment of residual flow is possible using thick-slice NCCT but less precise. 24 Almost all centers acquire thin-slice imaging initially but do not store such images: perviousness could be measured for many more patients if thin-slice imaging is preserved, and a practical, fast, (automatic) measurement method is available.…”

Section: Discussionmentioning

confidence: 99%

“…Thicker slices give a lower measured density on NCCT due to volume averaging with surrounding brain tissue. 24 In addition, CTA scan timing can influence TAI, by slightly differing scanning phase. Dynamic or multiphase CTA incorporates the time dimension by making CTA scans at multiple time points after contrast injection, which can avoid the issue of scanning too early after contrast bolus.…”

Section: Discussionmentioning

confidence: 99%

“…Training was done with 25 cases from the MR CLEAN Registry. 23 Scan acquisition characteristics including NCCT and CTA slice thickness difference (CTA slice thickness minus NCCT slice thickness), 24 scanner brand, and scanner kVp were recorded for all included patients.…”

Section: Methodsmentioning

confidence: 99%

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Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke

Kappelhof

Tolhuisen

Treurniet

et al. 2021

Stroke

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Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke

Kappelhof

Tolhuisen

Treurniet

et al. 2021

Stroke

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show abstract

“…It should be mentioned that there are other complex methods for the segmentation of the thrombus in NCCT [10][11][12]. Some of these methods incorporate vessel characteristics and information about contralateral anatomy.…”

Section: Discussionmentioning

confidence: 99%

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

Qazi

Wilson

et al. 2021

Diagnostics

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The hyperdense sign is a marker of thrombus in non-contrast computed tomography (NCCT) datasets. The aim of this work was to determine optimal Hounsfield unit (HU) thresholds for thrombus segmentation in thin-slice non-contrast CT (NCCT) and use these thresholds to generate 3D thrombus models. Patients with thin-slice baseline NCCT (≤2.5 mm) and MCA-M1 occlusions were included. CTA was registered to NCCT, and three regions of interest (ROIs) were placed in the NCCT, including: the thrombus, contralateral brain tissue, and contralateral patent MCA-M1 artery. Optimal HU thresholds differentiating the thrombus from non-thrombus tissue voxels were calculated using receiver operating characteristic analysis. Linear regression analysis was used to predict the optimal HU threshold for discriminating the clot only based on the average contralateral vessel HU or contralateral parenchyma HU. Three-dimensional models from 70 participants using standard (45 HU) and patient-specific thresholds were generated and compared to CTA clot characteristics. The optimal HU threshold discriminating thrombus in NCCT from other structures varied with a median of 51 (IQR: 49–55). Experts chose 3D models derived using patient-specific HU models as corresponding better to the thrombus seen in CTA in 83.8% (31/37) of cases. Patient-specific HU thresholds for segmenting the thrombus in NCCT can be derived using normal parenchyma. Thrombus segmentation using patient-specific HU thresholds is superior to conventional 45 HU thresholds.

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A review on the association of thrombus composition with mechanical and radiological imaging characteristics in acute ischemic stroke

Cahalane

Boodt

Akyildiz

et al. 2021

Journal of Biomechanics

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The Effect of Non-contrast CT Slice Thickness on Thrombus Density and Perviousness Assessment

Cited by 4 publications

References 12 publications

Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke

Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

A review on the association of thrombus composition with mechanical and radiological imaging characteristics in acute ischemic stroke

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