Department of Medical Imaging, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Centre, Stroke Research Program, St. Anne´s University Hospital, Brno, Czech Republic.
International Clinical Research Centre, Stroke Research Program, St. Anne´s University Hospital, Brno, Czech Republic; Departments of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Neurology, Faculty Hospital Ostrava, Ostrava, Czech Republic.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104978. doi: 10.1016/j.jstrokecerebrovasdis.2020.104978. Epub 2020 Jun 30.
The aim of the study was to compare the assessment of ischemic changes by expert reading and available automated software for non-contrast CT (NCCT) and CT perfusion on baseline multimodal imaging and demonstrate the accuracy for the final infarct prediction.
Early ischemic changes were measured by ASPECTS on the baseline neuroimaging of consecutive patients with anterior circulation ischemic stroke. The presence of early ischemic changes was assessed a) on NCCT by two experienced raters, b) on NCCT by e-ASPECTS, and c) visually on derived CT perfusion maps (CBF<30%, Tmax>10s). Accuracy was calculated by comparing presence of final ischemic changes on 24-hour follow-up for each ASPECTS region and expressed as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The subanalysis for patients with successful recanalization was conducted.
Of 263 patients, 81 fulfilled inclusion criteria. Median baseline ASPECTS was 9 for all tested modalities. Accuracy was 0.76 for e-ASPECTS, 0.79 for consensus, 0.82 for CBF<30%, 0.80 for Tmax>10s. e-ASPECTS, consensus, CBF<30%, and Tmax>10s had sensitivity 0.41, 0.46, 0.49, 0.57, respectively; specificity 0.91, 0.93, 0.95, 0.91, respectively; PPV 0.66, 0.75, 0.82, 0.73, respectively; NPV 0.78, 0.80, 0.82, 0.83, respectively. Results did not differ in patients with and without successful recanalization.
This study demonstrated high accuracy for the assessment of ischemic changes by different CT modalities with the best accuracy for CBF<30% and Tmax>10s. The use of automated software has a potential to improve the detection of ischemic changes.
本研究旨在比较专家阅读和可用的自动软件对非对比 CT（NCCT）和 CT 灌注的基线多模态成像评估缺血性改变，并证明其对最终梗死预测的准确性。
在前循环缺血性卒中连续患者的基线神经影像学中，通过 ASPECTS 测量早期缺血性改变。通过两位有经验的评估者评估 a）NCCT 上的早期缺血性改变，b）NCCT 上的 e-ASPECTS，以及 c）在衍生的 CT 灌注图上的视觉评估（CBF<30%，Tmax>10s）。通过比较每个 ASPECTS 区域的 24 小时随访中最终缺血性改变的存在来计算准确性，并表示为敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。对成功再通的患者进行了亚分析。
在 263 名患者中，81 名符合纳入标准。所有测试模态的基线 ASPECTS 中位数为 9。e-ASPECTS 的准确性为 0.76，共识为 0.79，CBF<30%为 0.82，Tmax>10s 为 0.80。e-ASPECTS、共识、CBF<30%和 Tmax>10s 的敏感性分别为 0.41、0.46、0.49、0.57，特异性分别为 0.91、0.93、0.95、0.91，PPV 分别为 0.66、0.75、0.82、0.73，NPV 分别为 0.78、0.80、0.82、0.83。在有和没有成功再通的患者中，结果没有差异。
本研究表明，不同 CT 模态评估缺血性改变的准确性较高，其中 CBF<30%和 Tmax>10s 的准确性最高。自动软件的使用有可能提高缺血性改变的检测能力。
