Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville, Victoria, 3050, Australia.
Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Neuroradiology. 2021 Oct;63(10):1645-1649. doi: 10.1007/s00234-021-02651-9. Epub 2021 Feb 12.
Endovascular thrombectomy (EVT) improves clinical outcomes in ischemic stroke with large vessel occlusion. Clinical benefits are inversely proportional to size of the pre-treatment ischemic core. This study compared estimated ischemic core volumes by two different CT perfusion (CTP) automated algorithms to the gold standard follow-up infarct volume using diffusion-weighted imaging (DWI) to assess for congruence, and thus eligibility for EVT.
Retrospective, single-center cohort study of 102 patients presenting to a comprehensive stroke center between 2012 and 2018. Inclusion criteria were CT perfusion prior to EVT, successful EVT with mTIBI 2b-3 reperfusion, and DWI post-EVT. CTP data were retrospectively processed by two algorithms: "delay and dispersion insensitive deconvolution" (DISD, RAPID software) versus "delay and dispersion corrected single value decomposition" (ddSVD, Mistar software), using commercially available software. Core volumes were compared to follow up DWI using independent software (MRIcron). Agreement between each algorithm and DWI was estimated using Lin's concordance coefficient and analyzed using reduced major axis regression.
We included 102 patients. Both algorithms had excellent agreement with DWI (Lin's concordance coefficients: DISD 0.8 (95% CI: 0.73; 0.87), ddSVD 0.92 (95% CI: 0.89; 0.95). Compared to ddSVD (reduced major axis slope = 0.95), DISD exhibited a larger extent of proportional bias (slope = 1.12).
The ddSVD algorithm better correlates with DWI follow-up infarct volume than DISD processing. The DISD algorithm overestimated larger ischemic cores which may lead to patient exclusion from thrombectomy based on selection by core volume.
血管内血栓切除术（EVT）可改善大动脉闭塞性缺血性卒中的临床转归。临床获益与治疗前缺血核心的大小成反比。本研究通过比较两种不同 CT 灌注（CTP）自动算法与使用弥散加权成像（DWI）评估一致性的金标准随访梗死体积，来比较估计的缺血核心体积，从而评估是否符合 EVT 的适应证。
这是一项回顾性、单中心队列研究，纳入了 2012 年至 2018 年期间在综合卒中中心就诊的 102 例患者。纳入标准为 EVT 前 CT 灌注、mTIBI 2b-3 再灌注成功的 EVT 以及 EVT 后 DWI。CTP 数据由两种算法（RAPID 软件中的“延迟和弥散不敏感解卷积”（DISD）与 Mistar 软件中的“延迟和弥散校正单值分解”（ddSVD））进行回顾性处理，使用的是商用软件。使用独立软件（MRIcron）将核心体积与随访 DWI 进行比较。使用 Lin 一致性系数估计每种算法与 DWI 的一致性，并使用简化主成分回归进行分析。
共纳入 102 例患者。两种算法与 DWI 均具有极好的一致性（Lin 一致性系数：DISD 为 0.8（95%CI：0.73；0.87），ddSVD 为 0.92（95%CI：0.89；0.95））。与 ddSVD（简化主成分回归斜率=0.95）相比，DISD 表现出更大的比例偏差（斜率=1.12）。
ddSVD 算法与 DWI 随访梗死体积的相关性优于 DISD 处理。DISD 算法高估了较大的缺血核心，这可能导致根据核心体积选择而将患者排除在血栓切除术之外。
