Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke
Détails
ID Serval
serval:BIB_4E6FE5CE02BB
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke
Périodique
Stroke
ISSN
1524-4628
Statut éditorial
Publié
Date de publication
04/2006
Peer-reviewed
Oui
Volume
37
Numéro
4
Pages
979-85
Notes
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Apr
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Apr
Résumé
BACKGROUND AND PURPOSE: Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. METHODS: One hundred and thirty patients with symptoms suggesting hemispheric stroke < or =12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performed to determine the most accurate PCT parameter, and the optimal threshold for each parameter, using DWI/FLAIR as the gold standard. RESULTS: The PCT parameter that most accurately describes the tissue at risk of infarction in case of persistent arterial occlusion is the relative MTT (area under the curve=0.962), with an optimal threshold of 145%. The PCT parameter that most accurately describes the infarct core on admission is the absolute CBV (area under the curve=0.927), with an optimal threshold at 2.0 ml x 100 g(-1). CONCLUSIONS: In a large series of 130 patients, the optimal approach to define the infarct and the penumbra is a combined approach using 2 PCT parameters: relative MTT and absolute CBV, with dedicated thresholds.
Mots-clé
Adult
Aged
Aged, 80 and over
Blood Volume
Brain/*radiography
Cerebral Infarction/diagnosis/*radiography
Cerebrovascular Circulation
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Prospective Studies
ROC Curve
Stroke/diagnosis/*radiography
Time Factors
*Tomography, X-Ray Computed
Pubmed
Web of science
Création de la notice
10/04/2008 16:28
Dernière modification de la notice
20/08/2019 15:03