Noncontrast Computed Tomography versus Computed Tomography Angiography Source Images for Predicting Final Infarct Size in Anterior Circulation Acute Ischemic Stroke: a Prospective Cohort Study

Mukherjee, Amritendu; Muthusami, Prakash; Mohimen, Aneesh; Srinivasan, K; Babunath, B; Sylaja, PN; Kesavadas, Chandrasekharan

doi:10.1016/j.jstrokecerebrovasdis.2016.09.026

Cited by 15 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, the factors that significantly associated with increased ASPECTS are TICI 2b/3 and good collateral status. This result corresponds with Sharma et al [18] and findings from recent studies[161819] that the CTA-SI hypoattenuated area may be similar to the infarct core with a penumbra zone and be closely correlated with cerebral blood flow on the perfusion CT, which may imply that the salvageable brain tissue may survive if good recanalization (TICI 2b/3) is achieved and the patients have a good collateral status.…”

Section: Discussionsupporting

confidence: 90%

Value of brain computed tomographic angiography to predict post thrombectomy final infarct size and clinical outcome in acute ischemic stroke

et al. 2019

View full text Add to dashboard Cite

Aims:This study aims to analyze the predictor in preoperative brain computed tomographic angiography (CTA) for final infarct and outcome in postendovascular thrombectomy patient.Subjects and Methods:52 patients were retrospectively reviewed. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) comparison between preoperative noncontrast computed tomography (NCCT) and 24-h NCCT as well as preoperative CTA source image (CTA-SI) and 24-h NCCT were performed. Factors associated with increased ASPECTS and clinical outcome were evaluated.Results:Preoperative NCCT ASPECTS = 24-h NCCT in 23%. Whereas, 46% showed preoperative CTA-SI ASPECTS = 24-h NCCT. Moreover, 40.4% showed 24-h NCCT ASPECTS > preoperative CTA-SI (increased ASPECTS). The two significant factors associated with increased ASPECTS are thrombolysis in cerebral infarct score 2b/3 (P = 0.02) and good collateral status (P = 0.02). Finally, good clinical outcome was associated with age <60 (P = 0.04), preoperative CTA-SI ASPECTS >5 (P = 0.01), good collaterals status (P = 0.02), and increased ASPECTS (P = 0.05).Conclusions:Preoperative brain CTA provided the necessary factors that are associated with good clinical outcomes, which are CTA-SI ASPECTS > 5, good collateral status, and increased ASPECTS.

show abstract

Section: Discussionsupporting

confidence: 90%

Value of brain computed tomographic angiography to predict post thrombectomy final infarct size and clinical outcome in acute ischemic stroke

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Notably, complex processing of 4D CTP data is necessary to produce reliable results and correct for different hemodynamics, which is not applicable for the described technique and CTA imaging in general. Nevertheless, attenuation changes on CTASI have frequently presented high sensitivity for ischemia and correlation with cerebral blood flow CTP maps [12,21,22]. This including our data indicate that CTA using bolus trigger seem to produce robust attenuation phases that are highly sensitive for tissue ischemia similar to CTP.…”

Section: Discussionsupporting

confidence: 62%

Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography

et al. 2020

View full text Add to dashboard Cite

Purpose Computed tomography angiography (CTA) is routinely used to detect large-vessel occlusion (LVO) in patients with suspected acute ischemic stroke; however, visual analysis is time consuming and prone to error. To evaluate solutions to support imaging triage, we tested performance of automated analysis of CTA source images (CTASI) at identifying patients with LVO. Methods Stroke patients with LVO were selected from a prospectively acquired cohort. A control group was selected from consecutive patients with clinically suspected stroke without signs of ischemia on CT perfusion (CTP) or infarct on follow-up. Software-based automated segmentation and Hounsfield unit (HU) measurements were performed on CTASI for all regions of the Alberta Stroke Program Early CT score (ASPECTS). We derived different parameters from raw measurements and analyzed their performance to identify patients with LVO using receiver operating characteristic curve analysis. Results The retrospective analysis included 145 patients, 79 patients with LVO stroke and 66 patients without stroke. The parameters hemispheric asymmetry ratio (AR), ratio between highest and lowest regional AR and M2-territory AR produced area under the curve (AUC) values from 0.95–0.97 (all p < 0.001) for detecting presence of LVO in the total population. Resulting sensitivity (sens)/specificity (spec) defined by the Youden index were 0.87/0.97–0.99. Maximum sens/spec defined by the specificity threshold ≥0.70 were 0.91–0.96/0.77–0.83. Performance in a small number of patients with isolated M2 occlusion was lower (AUC: 0.72–0.85). Conclusion Automated attenuation measurements on CTASI identify proximal LVO stroke patients with high sensitivity and specificity. This technique can aid in accurate and timely patient selection for thrombectomy, especially in primary stroke centers without CTP capacity.

show abstract

“…[ 4 ] Therefore, more experience is required for correct evaluation of EIC. CT angiography source image (CTA-SI), [ 5 – 9 ] CT perfusion source image (CTP-SI), [ 10 ] and cerebral blood volume on CTP (CTP-CBV) [ 11 ] may facilitate the evaluation of EIC. CTA-SI provides a measure of cerebral blood flow, [ 12 ] and by delineation of avascular areas, it can predict the final infarct extent more accurately than NCCT.…”

Section: Introductionmentioning

confidence: 99%

Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke

et al. 2018

View full text Add to dashboard Cite

Noncontrast computed tomography (NCCT) has been used for the detection of early ischemic change (EIC); however, correct interpretation of NCCT findings requires much clinical experience. This study aimed to assess the accuracy of time maximum intensity projection computed tomography technique (tMIP), which reflects the maximum value for the time phase direction from the dynamic volume data for each projected plane, for detection of EIC, against that of NCCT.Retrospective review of NCCT, cerebral blood volume in CT perfusion (CTP-CBV), and tMIP of 186 lesions from 280 regions evaluated by Alberta Stroke Program Early CT Score (ASPECTS) in 14 patients with acute middle cerebral artery stroke who had undergone whole-brain CTP using 320-row area detector CT was performed. Four radiologists reviewed EIC on NCCT, CTP-CBV, and tMIP in each ASPECTS region at onset using the continuous certainty factor method. Receiver operating characteristic analysis was performed to compare the relative performance for detection of EIC. The correlations were evaluated.tMIP-color showed the best discriminative value for detection of EIC. There were significant differences in the area under the curve for NCCT and tMIP-color, CTP-CBV (P < .05). Scatter plots of ASPECTS showed a positive significant correlation between NCCT, tMIP-gray, tMIP-color, and the follow-up study (NCCT, r = 0.32, P = .0166; tMIP-gray, r = 0.44, P = .0007; tMIP-color, r = 0.34, P = .0104).Because tMIP provides a high contrast parenchymal image with anatomical and vascular information in 1 sequential scan, it showed greater accuracy for detection of EIC and predicted the final infarct extent more accurately than NCCT based on ASPECTS.

show abstract

Noncontrast Computed Tomography versus Computed Tomography Angiography Source Images for Predicting Final Infarct Size in Anterior Circulation Acute Ischemic Stroke: a Prospective Cohort Study

Cited by 15 publications

References 24 publications

Value of brain computed tomographic angiography to predict post thrombectomy final infarct size and clinical outcome in acute ischemic stroke

Value of brain computed tomographic angiography to predict post thrombectomy final infarct size and clinical outcome in acute ischemic stroke

Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography

Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke

Contact Info

Product

Resources

About