Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Sci Rep. 2021 Mar 24;11(1):6745. doi: 10.1038/s41598-021-85143-3.
Dual-energy CT (DECT) material decomposition techniques may better detect edema within cerebral infarcts than conventional non-contrast CT (NCCT). This study compared if Virtual Ischemia Maps (VIM) derived from non-contrast DECT of patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are superior to NCCT for ischemic core estimation, compared against reference-standard DWI-MRI. Only patients whose baseline ischemic core was most likely to remain stable on follow-up MRI were included, defined as those with excellent post-thrombectomy revascularization or no perfusion mismatch. Twenty-four consecutive AIS-LVO patients with baseline non-contrast DECT, CT perfusion (CTP), and DWI-MRI were analyzed. The primary outcome measure was agreement between volumetric manually segmented VIM, NCCT, and automatically segmented CTP estimates of the ischemic core relative to manually segmented DWI volumes. Volume agreement was assessed using Bland-Altman plots and comparison of CT to DWI volume ratios. DWI volumes were better approximated by VIM than NCCT (VIM/DWI ratio 0.68 ± 0.35 vs. NCCT/DWI ratio 0.34 ± 0.35; P < 0.001) or CTP (CTP/DWI ratio 0.45 ± 0.67; P < 0.001), and VIM best correlated with DWI (r = 0.90; r = 0.75; r = 0.77; P < 0.001). Bland-Altman analyses indicated significantly greater agreement between DWI and VIM than NCCT core volumes (mean bias 0.60 [95%AI 0.39-0.82] vs. 0.20 [95%AI 0.11-0.30]). We conclude that DECT VIM estimates the ischemic core in AIS-LVO patients more accurately than NCCT.
双能 CT（DECT）物质分解技术可能比常规非增强 CT（NCCT）更好地检测脑梗死中的水肿。本研究比较了源自急性缺血性卒中患者（由于大血管闭塞）的非增强 DECT 的虚拟缺血图（VIM）与 NCCT 相比，对于缺血核心的估计是否优于 NCCT，与参考标准 DWI-MRI 进行比较。仅包括那些在随访 MRI 上缺血核心最有可能保持稳定的患者，这些患者定义为血栓切除术再通效果极好或没有灌注不匹配的患者。分析了 24 例连续的 AIS-LVO 患者的基线非增强 DECT、CT 灌注（CTP）和 DWI-MRI。主要观察指标是手动分割 VIM、NCCT 和自动分割 CTP 相对于手动分割 DWI 体积的缺血核心的容积一致性。使用 Bland-Altman 图和 CT 与 DWI 体积比的比较评估体积一致性。与 NCCT（VIM/DWI 比 0.68±0.35 与 NCCT/DWI 比 0.34±0.35；P<0.001）或 CTP（CTP/DWI 比 0.45±0.67；P<0.001）相比，VIM 更能近似 DWI，VIM 与 DWI 相关性最好（r=0.90；r=0.75；r=0.77；P<0.001）。Bland-Altman 分析表明，DWI 与 VIM 之间的一致性明显大于 NCCT 核心体积（平均偏差 0.60 [95%AI 0.39-0.82] 与 0.20 [95%AI 0.11-0.30]）。我们得出结论，DECT VIM 比 NCCT 更准确地估计 AIS-LVO 患者的缺血核心。
