Emmer B J, Rijkee M, Niesten J M, Wermer M J H, Velthuis B K, van Walderveen M A A
Department of Radiology, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands,
Neuroradiology. 2014 Dec;56(12):1121-6. doi: 10.1007/s00234-014-1429-9. Epub 2014 Sep 17.
Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice.
In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level.
Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10% as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4% for the 8-cm, 7% for the 4-cm, and 13% for the 3-cm coverage size.
This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage.
我们的目的是比较全脑CT灌注（CTP）与目前常规临床实践中使用的几种有限覆盖范围大小（即3、4、6和8厘米）下的梗死核心体积。
总共纳入了40例患有非增强CT（NCCT）和前循环缺血CTP成像的急性缺血性中风患者。使用320层CT进行成像。计算所有模拟部分覆盖范围大小下梗死核心的平均体积。将每个部分脑覆盖的梗死核心体积与全脑覆盖的梗死核心体积进行比较，并以百分比表示。为了确定每个模拟CTP覆盖范围的最佳起始位置，计算模拟部分覆盖在相对于急性中风分诊中的阿尔伯塔中风项目早期CT评分（ASPECTS 1）水平的每个可能起始位置的梗死覆盖百分比。
当底部层面位于ASPECTS 1水平时，与8厘米覆盖范围相比，全脑CTP覆盖使梗死核心体积显示的百分比进一步增加了10%。对于3厘米、4厘米和8厘米覆盖范围，感兴趣区域（ROI）位置的优化使8厘米覆盖范围的梗死显示百分比提高了4%，4厘米覆盖范围提高了7%，3厘米覆盖范围提高了13%。
本研究表明，全脑CTP是CTP的最佳覆盖范围，在量化梗死核心大小的准确性方面有显著提高。此外，我们的结果表明，有限覆盖范围内ROI的最佳位置取决于覆盖范围的大小。
