Fabrizio Giammello1,2, Sara Rosa Maria De Martino3, Luigi Simonetti4, Raffaele Agati5, Stella Battaglia5, Luigi Cirillo3,6, Mauro Gentile7, Ludovica Migliaccio7, Stefano Forlivesi7, Michele Romoli7, Ciro Princiotta3, Caterina Tonon8,9, Silvia Stagni4, Simone Galluzzo4, Raffaele Lodi8,9, Giuseppe Trimarchi10, Antonio Toscano11, Rosa Fortunata Musolino12, Andrea Zini7. 1. International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Polyclinic Hospital, Via Consolare Valeria 1, 98125, Messina, Italy. fabrizio.giammello@gmail.com. 2. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. fabrizio.giammello@gmail.com. 3. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bellaria Hospital, Bologna, Italy. 4. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy. 5. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Programma Neuroradiologia Con Tecniche Ad Elevata Complessità, Bellaria Hospital, Bologna, Italy. 6. DIMES, Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy. 7. Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy. 8. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. 9. Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy. 10. Faculty of Medicine and Surgery, University of Messina, Messina, Italy. 11. Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 12. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Abstract
PURPOSE: To assess utility of computed tomography perfusion (CTP) protocols for selection of patients with acute ischemic stroke (AIS) for reperfusive treatments and compare the diagnostic accuracy (ACC) in predicting follow-up infarction, using time-to-maximum (Tmax) maps. METHODS: We retrospectively reviewed consecutive AIS patients evaluated for reperfusive treatments at comprehensive stroke center, employing a multimodal computed tomography. To assess prognostic accuracy of CTP summary maps in predicting final infarct area (FIA) in AIS patients, we assumed the best correlation between non-viable tissue (NVT) and FIA in early and fully recanalized patients and/or in patients with favorable clinical response (FCR). On the other hand, the tissue at risk (TAR) should better correlate with FIA in untreated patients and in treatment failure. RESULTS: We enrolled 158 patients, for which CTP maps with Tmax thresholds of 9.5 s and 16 s, presented sensitivity of 82.5%, specificity of 74.6%, and ACC of 75.9%. In patients selected for perfusion deficit in anterior circulation territory, CTP-Tmax > 16 s has proven relatively reliable to identify NVT in FCR patients, with a tendency to overestimate NVT. Similarly, CTP-Tmax > 9.5 s was reliable for TAR, but it was overestimated comparing to FIA, in patients with unfavorable outcomes. CONCLUSIONS: In our experience, Tmax thresholds have proven sufficiently reliable to identify global hypoperfusion, with tendency to overestimate both NVT and TAR, not yielding satisfactory differentiation between true penumbra and benign oligoemia. In particular, the overestimation of NVT could have serious consequences in not selecting potential candidates for a reperfusion treatment.
PURPOSE: To assess utility of computed tomography perfusion (CTP) protocols for selection of patients with acute ischemic stroke (AIS) for reperfusive treatments and compare the diagnostic accuracy (ACC) in predicting follow-up infarction, using time-to-maximum (Tmax) maps. METHODS: We retrospectively reviewed consecutive AIS patients evaluated for reperfusive treatments at comprehensive stroke center, employing a multimodal computed tomography. To assess prognostic accuracy of CTP summary maps in predicting final infarct area (FIA) in AIS patients, we assumed the best correlation between non-viable tissue (NVT) and FIA in early and fully recanalized patients and/or in patients with favorable clinical response (FCR). On the other hand, the tissue at risk (TAR) should better correlate with FIA in untreated patients and in treatment failure. RESULTS: We enrolled 158 patients, for which CTP maps with Tmax thresholds of 9.5 s and 16 s, presented sensitivity of 82.5%, specificity of 74.6%, and ACC of 75.9%. In patients selected for perfusion deficit in anterior circulation territory, CTP-Tmax > 16 s has proven relatively reliable to identify NVT in FCR patients, with a tendency to overestimate NVT. Similarly, CTP-Tmax > 9.5 s was reliable for TAR, but it was overestimated comparing to FIA, in patients with unfavorable outcomes. CONCLUSIONS: In our experience, Tmax thresholds have proven sufficiently reliable to identify global hypoperfusion, with tendency to overestimate both NVT and TAR, not yielding satisfactory differentiation between true penumbra and benign oligoemia. In particular, the overestimation of NVT could have serious consequences in not selecting potential candidates for a reperfusion treatment.
Authors: Hiroyuki Kawano; Andrew Bivard; Longting Lin; Henry Ma; Xin Cheng; Richard Aviv; Billy O'Brien; Kenneth Butcher; Min Lou; Jingfen Zhang; Jim Jannes; Qiang Dong; Christopher R Levi; Mark W Parsons Journal: Brain Date: 2017-03-01 Impact factor: 13.501
Authors: Álvaro García-Tornel; Daniel Campos; Marta Rubiera; Sandra Boned; Marta Olivé-Gadea; Manuel Requena; Ludovico Ciolli; Marian Muchada; Jorge Pagola; David Rodriguez-Luna; Matias Deck; Jesus Juega; Noelia Rodríguez-Villatoro; Estela Sanjuan; Alejandro Tomasello; Carlos Piñana; David Hernández; José Álvarez-Sabin; Carlos A Molina; Marc Ribó Journal: Stroke Date: 2021-03-08 Impact factor: 7.914