Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
BMC Neurol. 2023 Jan 20;23(1):31. doi: 10.1186/s12883-023-03075-z.
Volumetric accuracy of using computed tomography perfusion (CTP) to estimate the post-treatment infarct in stroke patients with successful recanalization after mechanical thrombectomy (MT) has been studied a lot, however the spatial accuracy and its influence factors has not been fully investigated.
This retrospective study reviewed the data from consecutive anterior large vessel occlusion (LVO) patients who had baseline CTP, successful recanalization after MT, and post-treatment diffusion-weighed imaging (DWI). Ischemic core on baseline CTP was estimated using relative cerebral blood flood (CBF) of < 30%. The infarct area was outlined manually on post-treatment DWI, and registered to CTP. Spatial agreement was assessed using the Dice similarity coefficient (DSC) and average Hausdorff distance. According to the median DSC, the study population was dichotomized into high and low Dice groups. Univariable and multivariable regression analyses were used to determine the factors independently associated with the spatial agreement.
In 72 included patients, the median DSC was 0.26, and the median average Hausdorff distance was 1.77 mm. High Dice group showed significantly higher median ischemic core volume on baseline CTP (33.90 mL vs 3.40 mL, P < 0.001), lower proportion of moderate or severe leukoaraiosis [27.78% vs 52.78%, P = 0.031], and higher median infarct volume on follow-up DWI (51.17 mL vs 9.42 mL, P < 0.001) than low Dice group. Ischemic core volume on baseline CTP was found to be independently associated with the spatial agreement (OR, 1.092; P < 0.001).
CTP could help to spatially locate the post-treatment infarct in anterior LVO patients who achieving successful recanalization after MT. Ischemic core volume on baseline CTP was independently associated with the spatial agreement.
使用计算机断层灌注（CTP）来估计机械血栓切除术（MT）后成功再通的卒中患者的治疗后梗死的容积准确性已经得到了广泛研究，但是空间准确性及其影响因素尚未得到充分研究。
本回顾性研究回顾了连续的前大血管闭塞（LVO）患者的数据，这些患者基线时进行了 CTP，MT 后成功再通，并进行了治疗后弥散加权成像（DWI）。基线 CTP 上的缺血核心使用相对脑血流（CBF）<30%进行估计。梗死区在治疗后 DWI 上手动勾画，并与 CTP 进行配准。使用 Dice 相似系数（DSC）和平均 Hausdorff 距离评估空间一致性。根据中位数 DSC，研究人群被分为高 Dice 组和低 Dice 组。使用单变量和多变量回归分析确定与空间一致性独立相关的因素。
在 72 名纳入的患者中，中位数 DSC 为 0.26，中位数平均 Hausdorff 距离为 1.77mm。高 Dice 组在基线 CTP 上的缺血核心体积明显更大（33.90mL 比 3.40mL，P<0.001），中度或重度脑白质疏松症的比例较低[27.78%比 52.78%，P=0.031]，随访 DWI 上的梗死体积更高（51.17mL 比 9.42mL，P<0.001）。基线 CTP 上的缺血核心体积与空间一致性独立相关（OR，1.092；P<0.001）。
CTP 可以帮助在前循环 LVO 患者中定位 MT 后成功再通后的治疗后梗死。基线 CTP 上的缺血核心体积与空间一致性独立相关。
