Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke

Details

Serval ID
serval:BIB_4E6FE5CE02BB
Type
Article: article from journal or magazin.
Collection
Publications
Title
Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke
Journal
Stroke
Author(s)
Wintermark  M., Flanders  A. E., Velthuis  B., Meuli  R., van Leeuwen  M., Goldsher  D., Pineda  C., Serena  J., van der Schaaf  I., Waaijer  A., Anderson  J., Nesbit  G., Gabriely  I., Medina  V., Quiles  A., Pohlman  S., Quist  M., Schnyder  P., Bogousslavsky  J., Dillon  W. P., Pedraza  S.
ISSN
1524-4628
Publication state
Published
Issued date
04/2006
Peer-reviewed
Oui
Volume
37
Number
4
Pages
979-85
Notes
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Apr
Abstract
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.
Keywords
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
Create date
10/04/2008 15:28
Last modification date
20/08/2019 14:03
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