Correlation of <i>T</i><sub>max</sub> volumes with clinical outcome in anterior circulation stroke

Şeker, Fatih; Pfaff, Johannes; Potreck, Arne; Mundiyanapurath, Sibu; Ringleb, Peter A.; Bendszus, Martin; Möhlenbruch, Markus

doi:10.1002/brb3.772

Cited by 16 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results for correlation of initial perfusion imaging and FIVs were comparable to current literature (r-values between 0.58 and 0.78 33,34 ). With an average value of 66.1 ml, the FIV in patients with none or failed recanalization was lower compared to previous studies.…”

Section: Discussionsupporting

confidence: 89%

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

Pennig¹,

Thiele²,

Goertz³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

the purpose of this study was to compare the performance of arrival-time-insensitive (Ati) and arrivaltime-sensitive (AtS) computed tomography perfusion (ctp) algorithms in philips intelliSpace portal (v9, ISP) and to investigate optimal thresholds for ATI regarding the prediction of final infarct volume (FIV). Retrospective, single-center study with 54 patients (mean 67.0 ± 13.1 years, 68.5% male) who received Stroke-CT/CTP-imaging between 2010 and 2018 with occlusion of the middle cerebral artery in the M1-/proximal M2-segment or terminal internal carotid artery. FIV was determined on shortterm follow-up imaging in two patient groups: A) not attempted or failed mechanical thrombectomy (Mt) and B) successful Mt. AtS (default settings) and Ati (full-range of threshold settings regarding FIV prediction) maps were coregistered in 3D with FIV using voxel-wise overlap measurement. Based on an average imaging follow-up of 2.6 ± 2.1 days, the estimation regarding penumbra (group A, ATI: r = 0.63/0.69, ATS: r = 0.64) and infarct core (group B, ATI: r = 0.60/0.68, ATS: r = 0.63) was slightly higher in ATI but the effect was not significant (p > 0.05). Regarding ATI, Tmax (AUC 0.9) was the best estimator of the penumbra (group A), CBF relative to the contralateral hemisphere (AUC 0.80) showed the best estimation of the infarct core (group B). there was a broad range of thresholds of optimal Ati settings in both groups. prediction of fiV with Ati was slightly better compared to AtS. However, this difference was not significant. Since ATI showed a broad range of optimal thresholds, exact thresholds regarding the Ati algorithm should be evaluated in further prospective, clinical studies. Computed tomography perfusion (CTP) represents a valuable adjunct to unenhanced CT and CT-angiography (CTA) in the diagnosis of acute ischemic stroke (AIS), playing a vital role in clinical decision making 1-3. By generating a four-dimensional dataset of the brain, tissue perfusion parameters derived from CTP allow to differentiate between ischemic core and penumbra using selected combinations and thresholds 4. If CTP shows a prevalent mismatch between ischemic core and penumbra, patients can benefit from mechanical thrombectomy (MT) up to 24 hours after AIS onset 1. Moreover, an ischemic core volume of 70 ml is regarded as the critical threshold above which patients show a significantly worse clinical outcome; therefore, accurate core and penumbra measurements derived from CTP are essential 5,6. For many years, the arrival-time-sensitive (ATS) post-processing algorithm represented the standard for CTP, which was thoroughly tested during the last two decades 4,7-9. A potential limitation of ATS is its sensitivity to contrast agent arrival delay and dispersion 7,10 , which can be problematic in patients with reduced cardiac output,

show abstract

Section: Discussionsupporting

confidence: 89%

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

Pennig¹,

Thiele²,

Goertz³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…T max delay threshold 4 s seems to be optimal for early assessment of critically hypoperfused tissue (21). T max volume is a good predictor for clinical outcome in MCA occlusions (22). The threshold (T max ≥ 4 s) at a volume of 10 mL is optimal for predicting infarct growth with the maximal sensitivity and specificity (13).…”

Section: Discussionmentioning

confidence: 99%

History of Hypertension Is Associated With MR Hypoperfusion in Chinese Inpatients With DWI-Negative TIA

et al. 2019

View full text Add to dashboard Cite

Objectives: The present study aimed to examine the prevalence of and risk factors for magnetic resonance (MR) perfusion abnormality in a Chinese population with transient ischemic attack (TIA) and normal diffusion-weighted imaging (DWI) findings. Methods: Patients with TIA admitted to our stroke center between January 2015 and October 2017 were recruited to the present study. MRI, including both DWI and perfusion-weighted imaging (PWI), was performed within 7 days of symptom onset. Time to maximum of the residue function (T max ) maps were evaluated using the RAPID software (Ischemaview USA, Version 4.9) to determine hypoperfusion. Multivariate analysis was used to assess perfusion findings, clinical variables, medical history, cardio-metabolic, and the ABCD2 scores (age, blood pressure, clinical features, symptom duration, and diabetes). Results: Fifty-nine patients met the inclusion criteria. The prevalence of MR perfusion T max ≥ 4 s ≥ 0 ml and ≥ 10 mL were 72.9% (43/59) and 42.4% (25/59), respectively. Multivariate analyses revealed that history of hypertension is an independent factor associated with MR perfusion abnormality (T max ≥ 4 s ≥ 10 mL) for Chinese patients with TIA ( P = 0.033, adjusted OR = 4.11, 95% CI = 1.12–15.11). Proximal artery stenosis (>50%) tended to lead to a larger PW lesion on MRI ( p = 0.067, adjusted OR = 3.60, 95% CI = 0.91–14.20). Conclusion: Our results suggest that the prevalence of perfusion abnormality is high as assessed by RAPID using the parametric T max ≥ 4 s. History of hypertension is a strong predictor of focal perfusion abnormality as calculated by RAPID on T max map of TIA patients with negative DWI findings.

show abstract

“…Yet, the effect of endovascular treatment on clinical outcome is not completely understood. Contributing factors beyond reperfusion, including the underlying pathophysiology such as magnitude of immanent tissue injury, collateral circulation, clinical variables, or subsequent developments like recurring stroke or secondary hemorrhage, reasonably influence the clinical outcomes [ 11 , 31 ]. Additionally, the effect of MT on outcome may not only be attributed to penumbral salvage, but also on reducing secondary injury volumes, in particular ischemic brain edema [ 8 – 10 , 19 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

et al. 2021

View full text Add to dashboard Cite

Background The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome. Methods 99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging. Results In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a–2b) reperfusion (median 224 mL, IQR: 168–303 versus 158 mL, IQR: 129–225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17–110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85–0.95, p < 0.0001). Conclusions PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.

show abstract

Correlation of T_max volumes with clinical outcome in anterior circulation stroke

Cited by 16 publications

References 25 publications

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

History of Hypertension Is Associated With MR Hypoperfusion in Chinese Inpatients With DWI-Negative TIA

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

Contact Info

Product

Resources

About

Correlation of Tmax volumes with clinical outcome in anterior circulation stroke

Cited by 16 publications

References 25 publications

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue Volumes

History of Hypertension Is Associated With MR Hypoperfusion in Chinese Inpatients With DWI-Negative TIA

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

Contact Info

Product

Resources

About

Correlation of T_max volumes with clinical outcome in anterior circulation stroke