Christopher D d'Esterre1, Mari E Boesen1, Seong Hwan Ahn1, Pooneh Pordeli1, Mohamed Najm1, Priyanka Minhas1, Paniz Davari1, Enrico Fainardi1, Marta Rubiera1, Alexander V Khaw1, Andrea Zini1, Richard Frayne1, Michael D Hill1, Andrew M Demchuk1, Tolulope T Sajobi1, Nils D Forkert1, Mayank Goyal1, Ting Y Lee1, Bijoy K Menon2. 1. From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F., M.G., B.K.M.); Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada (C.D.d'E., M.E.B., S.H.A., M.N., R.F., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.); Department of Clinical Neurosciences, University of Western Ontario, London, Ontario, Canada (A.V.K.); and Department of Neurosciences, University Hospital, Modena, Italy (A.Z.). 2. From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F., M.G., B.K.M.); Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada (C.D.d'E., M.E.B., S.H.A., M.N., R.F., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.); Department of Clinical Neurosciences, University of Western Ontario, London, Ontario, Canada (A.V.K.); and Department of Neurosciences, University Hospital, Modena, Italy (A.Z.). docbijoymenon@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Among patients with acute ischemic stroke, we determine computed tomographic perfusion (CTP) thresholds associated with follow-up infarction at different stroke onset-to-CTP and CTP-to-reperfusion times. METHODS: Acute ischemic stroke patients with occlusion on computed tomographic angiography were acutely imaged with CTP. Noncontrast computed tomography and magnectic resonance diffusion-weighted imaging between 24 and 48 hours were used to delineate follow-up infarction. Reperfusion was assessed on conventional angiogram or 4-hour repeat computed tomographic angiography. Tmax, cerebral blood flow, and cerebral blood volume derived from delay-insensitive CTP postprocessing were analyzed using receiver-operator characteristic curves to derive optimal thresholds for combined patient data (pooled analysis) and individual patients (patient-level analysis) based on time from stroke onset-to-CTP and CTP-to-reperfusion. One-way ANOVA and locally weighted scatterplot smoothing regression was used to test whether the derived optimal CTP thresholds were different by time. RESULTS: One hundred and thirty-two patients were included. Tmax thresholds of >16.2 and >15.8 s and absolute cerebral blood flow thresholds of <8.9 and <7.4 mL·min(-1)·100 g(-1) were associated with infarct if reperfused <90 min from CTP with onset <180 min. The discriminative ability of cerebral blood volume was modest. No statistically significant relationship was noted between stroke onset-to-CTP time and the optimal CTP thresholds for all parameters based on discrete or continuous time analysis (P>0.05). A statistically significant relationship existed between CTP-to-reperfusion time and the optimal thresholds for cerebral blood flow (P<0.001; r=0.59 and 0.77 for gray and white matter, respectively) and Tmax (P<0.001; r=-0.68 and -0.60 for gray and white matter, respectively) parameters. CONCLUSIONS: Optimal CTP thresholds associated with follow-up infarction depend on time from imaging to reperfusion.
BACKGROUND AND PURPOSE: Among patients with acute ischemic stroke, we determine computed tomographic perfusion (CTP) thresholds associated with follow-up infarction at different stroke onset-to-CTP and CTP-to-reperfusion times. METHODS:Acute ischemic strokepatients with occlusion on computed tomographic angiography were acutely imaged with CTP. Noncontrast computed tomography and magnectic resonance diffusion-weighted imaging between 24 and 48 hours were used to delineate follow-up infarction. Reperfusion was assessed on conventional angiogram or 4-hour repeat computed tomographic angiography. Tmax, cerebral blood flow, and cerebral blood volume derived from delay-insensitive CTP postprocessing were analyzed using receiver-operator characteristic curves to derive optimal thresholds for combined patient data (pooled analysis) and individual patients (patient-level analysis) based on time from stroke onset-to-CTP and CTP-to-reperfusion. One-way ANOVA and locally weighted scatterplot smoothing regression was used to test whether the derived optimal CTP thresholds were different by time. RESULTS: One hundred and thirty-two patients were included. Tmax thresholds of >16.2 and >15.8 s and absolute cerebral blood flow thresholds of <8.9 and <7.4 mL·min(-1)·100 g(-1) were associated with infarct if reperfused <90 min from CTP with onset <180 min. The discriminative ability of cerebral blood volume was modest. No statistically significant relationship was noted between stroke onset-to-CTP time and the optimal CTP thresholds for all parameters based on discrete or continuous time analysis (P>0.05). A statistically significant relationship existed between CTP-to-reperfusion time and the optimal thresholds for cerebral blood flow (P<0.001; r=0.59 and 0.77 for gray and white matter, respectively) and Tmax (P<0.001; r=-0.68 and -0.60 for gray and white matter, respectively) parameters. CONCLUSIONS: Optimal CTP thresholds associated with follow-up infarction depend on time from imaging to reperfusion.
Authors: A Potreck; S Loebel; J Pfaff; L Østergaard; K Mouridsen; A Radbruch; M Bendszus; S Mundiyanapurath Journal: Eur Radiol Date: 2019-03-18 Impact factor: 5.315
Authors: D Sacks; B Baxter; B C V Campbell; J S Carpenter; C Cognard; D Dippel; M Eesa; U Fischer; K Hausegger; J A Hirsch; M S Hussain; O Jansen; M V Jayaraman; A A Khalessi; B W Kluck; S Lavine; P M Meyers; S Ramee; D A Rüfenacht; C M Schirmer; D Vorwerk Journal: AJNR Am J Neuroradiol Date: 2018-05-17 Impact factor: 3.825
Authors: Mayank Goyal; Mohammed A Almekhlafi; Christoph Cognard; Ryan McTaggart; Kristine Blackham; Alessandra Biondi; Aad van der Lugt; Charles B L M Majoie; Wim H van Zwam; H Bart van der Worp; Michael D Hill Journal: Neuroradiology Date: 2019-01 Impact factor: 2.804
Authors: Julian Klug; Elisabeth Dirren; Maria G Preti; Paolo Machi; Andreas Kleinschmidt; Maria I Vargas; Dimitri Van De Ville; Emmanuel Carrera Journal: J Cereb Blood Flow Metab Date: 2020-06-05 Impact factor: 6.200
Authors: M A Almekhlafi; W G Kunz; R A McTaggart; M V Jayaraman; M Najm; S H Ahn; E Fainardi; M Rubiera; A V Khaw; A Zini; M D Hill; A M Demchuk; M Goyal; B K Menon Journal: AJNR Am J Neuroradiol Date: 2019-12-05 Impact factor: 3.825
Authors: C C McDougall; L Chan; S Sachan; J Guo; R G Sah; B K Menon; A M Demchuk; M D Hill; N D Forkert; C D d'Esterre; P A Barber Journal: AJNR Am J Neuroradiol Date: 2020-10-01 Impact factor: 3.825