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CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform.

Abstract：

BACKGROUND AND PURPOSE:Admission infarct core lesion size is an important determinant of management and outcome in acute (<9 hours) stroke. Our purposes were to: (1) determine the optimal CT perfusion parameter to define infarct core using various postprocessing platforms; and (2) establish the degree of variability in threshold values between these different platforms. METHODS:We evaluated 48 consecutive cases with vessel occlusion and admission CT perfusion and diffusion-weighted imaging within 3 hours of each other. CT perfusion was acquired with a "second-generation" 66-second biphasic cine protocol and postprocessed using "standard" (from 2 vendors, "A-std" and "B-std") and "delay-corrected" (from 1 vendor, "A-dc") commercial software. Receiver operating characteristic curve analysis was performed comparing each CT perfusion parameter-both absolute and normalized to the contralateral uninvolved hemisphere-between infarcted and noninfarcted regions as defined by coregistered diffusion-weighted imaging. RESULTS:Cerebral blood flow had the highest accuracy (receiver operating characteristic area under the curve) for all 3 platforms (P<0.01). The maximal areas under the curve for each parameter were: absolute cerebral blood flow 0.88, cerebral blood volume 0.81, and mean transit time 0.82 and relative Cerebral blood flow 0.88, cerebral blood volume 0.83, and mean transit time 0.82. Optimal receiver operating characteristic operating point thresholds varied significantly between different platforms (Friedman test, P<0.01). CONCLUSIONS:Admission absolute and normalized "second-generation" cine acquired CT cerebral blood flow lesion volumes correlate more closely with diffusion-weighted imaging-defined infarct core than do those of CT cerebral blood volume or mean transit time. Although limited availability of diffusion-weighted imaging for some patients creates impetus to develop alternative methods of estimating core, the marked variability in quantification among different postprocessing software limits generalizability of parameter map thresholds between platforms.

journal_name

Stroke

journal_title

Stroke

authors

Kamalian S,Kamalian S,Maas MB,Goldmacher GV,Payabvash S,Akbar A,Schaefer PW,Furie KL,Gonzalez RG,Lev MH

doi

10.1161/STROKEAHA.110.610618

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

1923-8

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.110.610618

journal_volume

pub_type

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CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform.