S Dehkharghani1, R Bammer2, M Straka3, L S Albin4, O Kass-Hout5, J W Allen4, S Rangaraju6, D Qiu4, M J Winningham6, F Nahab6. 1. From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.) rbammer@stanford.edu seena.dehkharghani@emory.edu. 2. Department of Radiology (R.B.), Stanford University Hospital, Stanford, California rbammer@stanford.edu seena.dehkharghani@emory.edu. 3. Institut für Radiologie und Nuklearmedizin (M.S.), Kantonsspital Winterthur, Winterthur, Switzerland. 4. From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.). 5. Department of Neurology (O.K.-H.), Catholic Health System, Buffalo, New York. 6. Neurology (S.R., M.J.W., F.N.), Emory University Hospital, Atlanta, Georgia.
Abstract
BACKGROUND AND PURPOSE: Treatment strategies in acute ischemic stroke aim to curtail ischemic progression. Emerging paradigms propose patient subselection using imaging biomarkers derived from CT, CTA, and CT perfusion. We evaluated the performance of a fully-automated computational tool, hypothesizing enhancements compared with qualitative approaches. The correlation between imaging variables and clinical outcomes in a cohort of patients with acute ischemic stroke is reported. MATERIALS AND METHODS: Sixty-two patients with acute ischemic stroke and MCA or ICA occlusion undergoing multidetector CT, CTA, and CTP were retrospectively evaluated. CTP was processed on a fully operator-independent platform (RApid processing of PerfusIon and Diffusion [RAPID]) computing automated core estimates based on relative cerebral blood flow and relative cerebral blood volume and hypoperfused tissue volumes at varying thresholds of time-to-maximum. Qualitative analysis was assigned by 2 independent reviewers for each variable, including CT-ASPECTS, CBV-ASPECTS, CBF-ASPECTS, CTA collateral score, and CTA clot burden score. Performance as predictors of favorable clinical outcome and final infarct volume was established for each variable. RESULTS: Both RAPID core estimates, CT-ASPECTS, CBV-ASPECTS, and clot burden score correlated with favorable clinical outcome (P < .05); CBF-ASPECTS and collateral score were not significantly associated with favorable outcome, while hypoperfusion estimates were variably associated, depending on the selected time-to-maximum thresholds. Receiver operating characteristic analysis demonstrated disparities among tested variables, with RAPID core and hypoperfusion estimates outperforming all qualitative approaches (area under the curve, relative CBV = 0.86, relative CBF = 0.81; P < .001). CONCLUSIONS: Qualitative approaches to acute ischemic stroke imaging are subject to limitations due to their subjective nature and lack of physiologic information. These findings support the benefits of high-speed automated analysis, outperforming conventional methodologies while limiting delays in clinical management.
BACKGROUND AND PURPOSE: Treatment strategies in acute ischemic stroke aim to curtail ischemic progression. Emerging paradigms propose patient subselection using imaging biomarkers derived from CT, CTA, and CT perfusion. We evaluated the performance of a fully-automated computational tool, hypothesizing enhancements compared with qualitative approaches. The correlation between imaging variables and clinical outcomes in a cohort of patients with acute ischemic stroke is reported. MATERIALS AND METHODS: Sixty-two patients with acute ischemic stroke and MCA or ICA occlusion undergoing multidetector CT, CTA, and CTP were retrospectively evaluated. CTP was processed on a fully operator-independent platform (RApid processing of PerfusIon and Diffusion [RAPID]) computing automated core estimates based on relative cerebral blood flow and relative cerebral blood volume and hypoperfused tissue volumes at varying thresholds of time-to-maximum. Qualitative analysis was assigned by 2 independent reviewers for each variable, including CT-ASPECTS, CBV-ASPECTS, CBF-ASPECTS, CTA collateral score, and CTA clot burden score. Performance as predictors of favorable clinical outcome and final infarct volume was established for each variable. RESULTS: Both RAPID core estimates, CT-ASPECTS, CBV-ASPECTS, and clot burden score correlated with favorable clinical outcome (P < .05); CBF-ASPECTS and collateral score were not significantly associated with favorable outcome, while hypoperfusion estimates were variably associated, depending on the selected time-to-maximum thresholds. Receiver operating characteristic analysis demonstrated disparities among tested variables, with RAPID core and hypoperfusion estimates outperforming all qualitative approaches (area under the curve, relative CBV = 0.86, relative CBF = 0.81; P < .001). CONCLUSIONS: Qualitative approaches to acute ischemic stroke imaging are subject to limitations due to their subjective nature and lack of physiologic information. These findings support the benefits of high-speed automated analysis, outperforming conventional methodologies while limiting delays in clinical management.
Authors: Gregory W Albers; Vincent N Thijs; Lawrence Wechsler; Stephanie Kemp; Gottfried Schlaug; Elaine Skalabrin; Roland Bammer; Wataru Kakuda; Maarten G Lansberg; Ashfaq Shuaib; William Coplin; Scott Hamilton; Michael Moseley; Michael P Marks Journal: Ann Neurol Date: 2006-11 Impact factor: 10.422
Authors: Stephen M Davis; Geoffrey A Donnan; Mark W Parsons; Christopher Levi; Kenneth S Butcher; Andre Peeters; P Alan Barber; Christopher Bladin; Deidre A De Silva; Graham Byrnes; Jonathan B Chalk; John N Fink; Thomas E Kimber; David Schultz; Peter J Hand; Judith Frayne; Graeme Hankey; Keith Muir; Richard Gerraty; Brian M Tress; Patricia M Desmond Journal: Lancet Neurol Date: 2008-02-28 Impact factor: 44.182
Authors: R I Aviv; J Mandelcorn; S Chakraborty; D Gladstone; S Malham; G Tomlinson; A J Fox; S Symons Journal: AJNR Am J Neuroradiol Date: 2007-10-05 Impact factor: 3.825
Authors: Jean-Marc Olivot; Michael Mlynash; Vincent N Thijs; Stephanie Kemp; Maarten G Lansberg; Lawrence Wechsler; Roland Bammer; Michael P Marks; Gregory W Albers Journal: Stroke Date: 2008-12-24 Impact factor: 7.914
Authors: M T Berndt; C Maegerlein; T Boeckh-Behrens; S Wunderlich; C Zimmer; S Wirth; F G Mück; S Mönch; B Friedrich; J Kaesmacher Journal: AJNR Am J Neuroradiol Date: 2019-12-19 Impact factor: 3.825
Authors: S Dehkharghani; R Bammer; M Straka; M Bowen; J W Allen; S Rangaraju; J Kang; T Gleason; C Brasher; F Nahab Journal: AJNR Am J Neuroradiol Date: 2016-03-10 Impact factor: 3.825
Authors: S Dehkharghani; M Bowen; D C Haussen; T Gleason; A Prater; Q Cai; J Kang; R G Nogueira Journal: AJNR Am J Neuroradiol Date: 2016-10-06 Impact factor: 3.825
Authors: Meredith T Bowen; Leticia C Rebello; Mehdi Bouslama; Diogo C Haussen; Jonathan A Grossberg; Nicolas A Bianchi; Samir Belagaje; Aaron Anderson; Michael R Frankel; Raul G Nogueira Journal: Interv Neurol Date: 2017-11-23
Authors: Mehdi Bouslama; Leticia C Rebello; Diogo C Haussen; Jonathan A Grossberg; Aaron M Anderson; Samir R Belagaje; Nicolas A Bianchi; Michael R Frankel; Raul G Nogueira Journal: Interv Neurol Date: 2018-06-19
Authors: Diogo C Haussen; Mehdi Bouslama; Seena Dehkharghani; Jonathan A Grossberg; Nicolas Bianchi; Meredith Bowen; Michael R Frankel; Raul G Nogueira Journal: Interv Neurol Date: 2018-05-17