Meaghan Reid1,2, Akinrinola O Famuyide3,4, Nils D Forkert2,3,4, Aron Sahand Talai4, James W Evans5, Amith Sitaram2,3, Moiz Hafeez1,2, Mohamed Najm2, Bijoy K Menon2,3,6, Andrew Demchuk2,3, Mayank Goyal2,3,4, Rani Gupta Sah2,3,4, Christopher D d'Esterre2,3,4, Philip Barber7,8,9. 1. Department of Medical Sciences, University of Calgary, Calgary, Canada. 2. Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, AB T2N 4N1, Calgary, Canada. 3. Seaman Family Center, University of Calgary, Calgary, Canada. 4. Department of Radiology, University of Calgary, Calgary, Canada. 5. Department of Neurosciences, Gosford Hospital, Gosford, Australia. 6. Department of Community Health Sciences, University of Calgary, Calgary, Canada. 7. Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, AB T2N 4N1, Calgary, Canada. pabarber@ucalgary.ca. 8. Seaman Family Center, University of Calgary, Calgary, Canada. pabarber@ucalgary.ca. 9. Department of Radiology, University of Calgary, Calgary, Canada. pabarber@ucalgary.ca.
Abstract
PURPOSE: Acute stroke treatment requires simple, quick and accurate detection of early ischemic changes to facilitate treatment decisions guided by published selection criteria. The aim of this study was to determine the accuracy and reliability of multiphase computed tomography angiography (mCTA) perfusion hypoattenuation for detecting early severe ischemia. METHODS: Non-contrast CT (NCCT), mCTA for regional leptomeningeal score (mCTA-rLMC), and mCTA perfusion lesion visibility (mCTA-arterial and mCTA-venous) were assessed blinded to clinical information in patients treated with endovascular therapy (EVT). The extent of early ischemia defined by regions of hypoattenuation was evaluated by the Alberta Stroke Program Early CT Score (ASPECTS). The ASPECTS scores were dichotomized based on the American Heart Association (AHA) guidelines for EVT selection, ASPECTS ≥6 vs. <6. The diagnostic accuracy was calculated by comparison to 24-h magnetic resonance imaging (MRI) or CT ASPECTS. Inter-observer reliability of NCCT and mCTA ASPECTS was evaluated. Machine learning models were used to predict the clinical follow-up outcome, e.g. National Institutes of Health Stroke scale (NIHSS) and modified Rankin scale (mRS) from baseline imaging data and patient information. RESULTS: A total of 89 acute stroke patients (68 ± 15 years of age) were analyzed (33 TICI-0, 56 TICI-2b or 3). Median baseline NIHSS was 17. The mCTA-venous had a large effect on accurately identifying early ischemia when dichotomized for ASPECTS ≥6 vs <6 (likelihood ratio [LR+] > 10 vs. [LR-] < 0.29) compared to the moderate effect of NCCT ([LR+] = 6.7; [LR-] = 0.56) and mCTA-rLMC [(LR+ = 8.0; (LR-) = 0.83)]. The inter-observer reliability in mCTA-venous was almost perfect for all ASPECTS regions except the internal capsule. The machine learning support factor regression model identified mCTA-venous as the most important imaging covariate for predicting 24-h NIHSS and 90-day mRS. CONCLUSION: The assessment of mCTA-venous permits a more accurate detection of early ischemia than NCCT and mCTA-rLMC score and is predictive of clinical outcome. We would recommend the inclusion of mCTA perfusion lesion in future endovascular trials aiming at extending current AHA guidelines for EVT in stroke patients with low ASPECTS.
PURPOSE:Acute stroke treatment requires simple, quick and accurate detection of early ischemic changes to facilitate treatment decisions guided by published selection criteria. The aim of this study was to determine the accuracy and reliability of multiphase computed tomography angiography (mCTA) perfusion hypoattenuation for detecting early severe ischemia. METHODS: Non-contrast CT (NCCT), mCTA for regional leptomeningeal score (mCTA-rLMC), and mCTA perfusion lesion visibility (mCTA-arterial and mCTA-venous) were assessed blinded to clinical information in patients treated with endovascular therapy (EVT). The extent of early ischemia defined by regions of hypoattenuation was evaluated by the Alberta Stroke Program Early CT Score (ASPECTS). The ASPECTS scores were dichotomized based on the American Heart Association (AHA) guidelines for EVT selection, ASPECTS ≥6 vs. <6. The diagnostic accuracy was calculated by comparison to 24-h magnetic resonance imaging (MRI) or CT ASPECTS. Inter-observer reliability of NCCT and mCTA ASPECTS was evaluated. Machine learning models were used to predict the clinical follow-up outcome, e.g. National Institutes of Health Stroke scale (NIHSS) and modified Rankin scale (mRS) from baseline imaging data and patient information. RESULTS: A total of 89 acute strokepatients (68 ± 15 years of age) were analyzed (33 TICI-0, 56 TICI-2b or 3). Median baseline NIHSS was 17. The mCTA-venous had a large effect on accurately identifying early ischemia when dichotomized for ASPECTS ≥6 vs <6 (likelihood ratio [LR+] > 10 vs. [LR-] < 0.29) compared to the moderate effect of NCCT ([LR+] = 6.7; [LR-] = 0.56) and mCTA-rLMC [(LR+ = 8.0; (LR-) = 0.83)]. The inter-observer reliability in mCTA-venous was almost perfect for all ASPECTS regions except the internal capsule. The machine learning support factor regression model identified mCTA-venous as the most important imaging covariate for predicting 24-h NIHSS and 90-day mRS. CONCLUSION: The assessment of mCTA-venous permits a more accurate detection of early ischemia than NCCT and mCTA-rLMC score and is predictive of clinical outcome. We would recommend the inclusion of mCTA perfusion lesion in future endovascular trials aiming at extending current AHA guidelines for EVT in strokepatients with low ASPECTS.
Authors: Bijoy K Menon; Christopher D d'Esterre; Emmad M Qazi; Mohammed Almekhlafi; Leszek Hahn; Andrew M Demchuk; Mayank Goyal Journal: Radiology Date: 2015-01-29 Impact factor: 11.105
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: David Rodriguez-Luna; Dar Dowlatshahi; Richard I Aviv; Carlos A Molina; Yolanda Silva; Imanuel Dzialowski; Cheemun Lum; Anna Czlonkowska; Jean-Martin Boulanger; Carlos S Kase; Gord Gubitz; Rohit Bhatia; Vasantha Padma; Jayanta Roy; Teri Stewart; Thien J Huynh; Michael D Hill; Andrew M Demchuk Journal: Stroke Date: 2014-01-30 Impact factor: 7.914
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Shelagh B Coutts; Michael H Lev; Michael Eliasziw; Luca Roccatagliata; Michael D Hill; Lee H Schwamm; J H Warwick Pexman; Walter J Koroshetz; Mark E Hudon; Alastair M Buchan; R Gilberto Gonzalez; Andrew M Demchuk Journal: Stroke Date: 2004-10-14 Impact factor: 7.914
Authors: Olga Finlayson; Verity John; Robert Yeung; Dar Dowlatshahi; Peter Howard; Liying Zhang; Rick Swartz; Richard I Aviv Journal: Stroke Date: 2012-10-25 Impact factor: 7.914
Authors: Nathan A Shlobin; Ammad A Baig; Muhammad Waqas; Tatsat R Patel; Rimal H Dossani; Megan Wilson; Justin M Cappuzzo; Adnan H Siddiqui; Vincent M Tutino; Elad I Levy Journal: World Neurosurg Date: 2021-12-08 Impact factor: 2.210
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
Authors: Kamil Zeleňák; Antonín Krajina; Lukas Meyer; Jens Fiehler; Daniel Behme; Deniz Bulja; Jildaz Caroff; Amar Ajay Chotai; Valerio Da Ros; Jean-Christophe Gentric; Jeremy Hofmeister; Omar Kass-Hout; Özcan Kocatürk; Jeremy Lynch; Ernesto Pearson; Ivan Vukasinovic Journal: Life (Basel) Date: 2021-05-27