Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: Qualitative and quantitative analysis of 3D parameter maps

Dolatowski, Karoline; Malinova, Vesna; Frölich, Andreas; Schramm, Ramona; Haberland, Ulrike; Klotz, Ernst; Mielke, Dorothee; Knauth, Michael; Schramm, Peter

doi:10.1016/j.ejrad.2014.06.020

Cited by 23 publications

(13 citation statements)

References 26 publications

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“…Nonetheless, the variability in the results defining the values of penumbra and core is mainly linked to the software applications of various companies, utilising different mathematical algorithms [11,22,23].…”

Section: Discussionmentioning

confidence: 99%

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

Gleń¹,

Chrzan²,

Urbanik³

2019

Pol J Radiol

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Purpose Assessment of software applications designed for post-processing of CT imaging data and perfusion maps in terms of their ability to consistently define the penumbra and core in an ischemic area. Material and methods This study is based on measurements conducted in a group of 65 patients with neurological symptoms suggestive of ischaemia in the area of the MCA within 12 hours following onset of the first symptoms. Non-contrast and perfusion CT were performed during an emergency duty. The acquired data were processed using various programs to obtain defined ischaemic areas and parameters. Finally, the results obtained were compared to the distribution of penumbra and core within the ischaemic area received from different perfusion mapping programs. Results The programs designed to convert the acquired data and to map the distribution of perfusion were also assessed for their viability in dividing the ischaemic zone into penumbra and core. There was a statistically strong correlation (0.784-0.846) between results obtained by processing of imaging data with two different packages, and then by post-processing with one package, and a poor correlation (0.315-0.554) between results obtained by processing of data with the same package, and post-processing with two different packages designed for measuring penumbra and core areas. Conclusions The results obtained by processing of imaging data with different software applications and by post-processing with one program developed for identifying penumbra and core areas show a strong correlation. However, the results obtained by processing imaging data with the same software application and by post-processing with different programs measuring penumbra and core areas reveal poor correlation.

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Section: Discussionmentioning

confidence: 99%

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

Gleń¹,

Chrzan²,

Urbanik³

2019

Pol J Radiol

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“…In addition, in many hospitals, MRI is still not available around the clock. Several technical improvements for CTP imaging are currently being investigated [ 18 – 20 ]. This may make more accurate estimation of irreversible ischemia possible in the future.…”

Section: Discussionmentioning

confidence: 99%

CT perfusion during delayed cerebral ischemia after subarachnoid hemorrhage: distinction between reversible ischemia and ischemia progressing to infarction

et al. 2015

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IntroductionDelayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. In patients with a deterioration clinically diagnosed as DCI, we investigated whether CT perfusion (CTP) can distinguish between reversible ischemia and ischemia progressing to cerebral infarction.MethodsFrom a prospectively collected series of aSAH patients, we included those with DCI, CTP on the day of clinical deterioration, and follow-up imaging. In qualitative CTP analyses (visual assessment), we calculated positive and negative predictive value (PPV and NPV) with 95 % confidence intervals (95%CI) of a perfusion deficit for infarction on follow-up imaging. In quantitative analyses, we compared perfusion values of the least perfused brain tissue between patients with and without infarction by using receiver-operator characteristic curves and calculated a threshold value with PPV and NPV for the perfusion parameter with the highest area under the curve.ResultsIn qualitative analyses of 33 included patients, 15 of 17 patients (88 %) with and 6 of 16 patients (38 %) without infarction on follow-up imaging had a perfusion deficit during clinical deterioration (p = 0.002). Presence of a perfusion deficit had a PPV of 71 % (95%CI: 48–89 %) and NPV of 83 % (95%CI: 52–98 %) for infarction on follow-up. Quantitative analyses showed that an absolute minimal cerebral blood flow (CBF) threshold of 17.7 mL/100 g/min had a PPV of 63 % (95%CI: 41–81 %) and a NPV of 78 % (95%CI: 40–97 %) for infarction.ConclusionsCTP may differ between patients with DCI who develop infarction and those who do not. For this purpose, qualitative evaluation may perform marginally better than quantitative evaluation.

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“…Patients with symptoms of vasospasm, increased BFV in TCD, abnormal CTP data (defined as highly visual abnormality on the parameter maps in more than one-third of 1 or more vascular territories), and arterial vasospasm on single-phase CTA axial and coronal MIP reconstructions underwent DSA, with the possibility to perform endovascular treatment. 6 The perfusion deficits were divided into 2 main groups of territorial and nonterritorial. Territorial perfusion deficits were diagnosed if the perfusion deficit was confined to a vessel territory (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Axial and coronal reconstructions of maximum-intensity projections (MIP), with a 10-mm slice thickness and a 3-mm interslice distance, were subsequently made. 6 …”

Section: Imaging Protocolmentioning

confidence: 99%

Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage

Malinova¹,

Dolatowski

Schramm

et al. 2016

JNS

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C erebral infarction with permanent vasospasminduced delayed ischemic neurological deficits (DIND) after aneurysmal subarachnoid hemorrhage (aSAH) is a feared and unfortunately frequent complication, responsible for poor functional and overall outcome. 2 The pathophysiology of DIND and vasospasminduced delayed cerebral infarction (DCI) after aSAH is multifactorial and still not fully understood. It is well accepted that vasospasm is a major contributor to DIND and DCI, but it is also assumed that processes already initiated shortly after aSAH render some brain areas more vulnerable for vasospasm than others. 20,27,33 In up to 15% of patients, cerebral infarction and a fixed neurological deficit (including death) are irreversible end points of a dynamic process starting with tissue predisposition and asymptomatic vasospasm, followed by symptomatic vasospasm and transient DIND. For the successful prevention of infarction by antivasospastic therapy, timely recognition of abbreviatioNs aSAH = aneurysmal subarachnoid hemorrhage; BFV = blood flow velocity; CBF = cerebral blood flow; CBV = cerebral blood volume; CTA = CT angiography; CTP = CT perfusion; DCI = delayed cerebral infarction; DIND = delayed ischemic neurological deficits; DSA = digital subtraction angiography; MIP = maximum-intensity projection; MTT = mean transit time; NPV = negative predictive value; PPV = positive predictive value; ROI = region of interest; TCD = transcranial Doppler sonography; TTP = time to peak; TTS = time to start. obJective This prospective study investigated the role of whole-brain CT perfusion (CTP) studies in the identification of patients at risk for delayed ischemic neurological deficits (DIND) and of tissue at risk for delayed cerebral infarction (DCI). methods Forty-three patients with aneurysmal subarachnoid hemorrhage (aSAH) were included in this study. A CTP study was routinely performed in the early phase (Day 3). The CTP study was repeated in cases of transcranial Doppler sonography (TCD)-measured blood flow velocity (BFV) increase of > 50 cm/sec within 24 hours and/or on Day 7 in patients who were intubated/sedated. results Early CTP studies revealed perfusion deficits in 14 patients, of whom 10 patients (72%) developed DIND, and 6 of these 10 patients (60%) had DCI. Three of the 14 patients (21%) with early perfusion deficits developed DCI without having had DIND, and the remaining patient (7%) had neither DIND nor DCI. There was a statistically significant correlation between early perfusion deficits and occurrence of DIND and DCI (p < 0.0001). A repeated CTP was performed in 8 patients with a TCD-measured BFV increase > 50 cm/sec within 24 hours, revealing a perfusion deficit in 3 of them (38%). Two of the 3 patients (67%) developed DCI without preceding DIND and 1 patient (33%) had DIND without DCI. In 4 of the 7 patients (57%) who were sedated and/or comatose, additional CTP studies on Day 7 showed perfusion deficits. All 4 patients developed DCI. coNclusioNs Whole-brain CTP on Day 3 after aSAH allows early and rel...

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Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: Qualitative and quantitative analysis of 3D parameter maps

Cited by 23 publications

References 26 publications

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography

CT perfusion during delayed cerebral ischemia after subarachnoid hemorrhage: distinction between reversible ischemia and ischemia progressing to infarction

Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage

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