Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands.
Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands.
Eur Radiol. 2021 Nov;31(11):8317-8325. doi: 10.1007/s00330-021-08067-6. Epub 2021 May 28.
To report the variation in computed tomography perfusion (CTP) arterial input function (AIF) in a multicenter stroke study and to assess the impact this has on CTP results.
CTP datasets from 14 different centers were included from the DUtch acute STroke (DUST) study. The AIF was taken as a direct measure to characterize contrast bolus injection. Statistical analysis was applied to evaluate differences in amplitude, area under the curve (AUC), bolus arrival time (BAT), and time to peak (TTP). To assess the clinical relevance of differences in AIF, CTP acquisitions were simulated with a realistic anthropomorphic digital phantom. Perfusion parameters were extracted by CTP analysis using commercial software (IntelliSpace Portal (ISP), version 10.1) as well as an in-house method based on block-circulant singular value decomposition (bSVD).
A total of 1422 CTP datasets were included, ranging from 6 to 322 included patients per center. The measured values of the parameters used to characterize the AIF differed significantly with approximate interquartile ranges of 200-750 HU for the amplitude, 2500-10,000 HU·s for the AUC, 0-17 s for the BAT, and 10-26 s for the TTP. Mean infarct volumes of the phantom were significantly different between centers for both methods of perfusion analysis.
Although guidelines for the acquisition protocol are often provided for centers participating in a multicenter study, contrast medium injection protocols still vary. The resulting volumetric differences in infarct core and penumbra may impact clinical decision making in stroke diagnosis.
• The contrast medium injection protocol may be different between stroke centers participating in a harmonized multicenter study. • The contrast medium injection protocol influences the results of X-ray computed tomography perfusion imaging. • The contrast medium injection protocol can impact stroke diagnosis and patient selection for treatment.
报告多中心卒中研究中计算机断层灌注（CTP）动脉输入功能（AIF）的变化，并评估其对 CTP 结果的影响。
纳入来自 DUtch acute STroke（DUST）研究的 14 个不同中心的 CTP 数据集。AIF 被作为直接测量来描述对比剂团注。应用统计分析评估幅度、曲线下面积（AUC）、对比剂到达时间（BAT）和峰值时间（TTP）的差异。为了评估 AIF 差异的临床相关性，使用逼真的人体数字体模模拟 CTP 采集。使用商业软件（IntelliSpace Portal（ISP），版本 10.1）和基于块循环奇异值分解（bSVD）的内部方法提取 CTP 分析中的灌注参数。
共纳入 1422 份 CTP 数据集，每个中心包含 6 至 322 例患者。用于描述 AIF 的参数的测量值差异显著，幅度的近似四分位间距为 200-750 HU，AUC 的为 2500-10000 HU·s，BAT 的为 0-17 s，TTP 的为 10-26 s。两种灌注分析方法的体模平均梗死体积在中心之间差异显著。
尽管通常为参与多中心研究的中心提供采集方案指南，但对比剂注射方案仍存在差异。核心梗死区和半影区的体积差异可能会影响卒中诊断的临床决策。
• 参与协调多中心研究的卒中中心的对比剂注射方案可能不同。
• 对比剂注射方案影响 X 射线计算机断层灌注成像的结果。
• 对比剂注射方案会影响卒中诊断和治疗选择的患者。
