Koopman Miou S, Hoving Jan W, Tolhuisen Manon L, Jin Peng, Thiele Frank O, Bremer-van der Heiden Linda, van Voorst Henk, Berkhemer Olvert A, Coutinho Jonathan M, Beenen Ludo F M, Marquering Henk A, Emmer Bart J, Majoie Charles B L M
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Cardiovasc Dev Dis. 2023 May 30;10(6):239. doi: 10.3390/jcdd10060239.
Computed tomography perfusion (CTP) is frequently used in the triage of ischemic stroke patients for endovascular thrombectomy (EVT). We aimed to quantify the volumetric and spatial agreement of the CTP ischemic core estimated with different thresholds and follow-up MRI infarct volume on diffusion-weighted imaging (DWI). Patients treated with EVT between November 2017 and September 2020 with available baseline CTP and follow-up DWI were included. Data were processed with Philips IntelliSpace Portal using four different thresholds. Follow-up infarct volume was segmented on DWI. In 55 patients, the median DWI volume was 10 mL, and median estimated CTP ischemic core volumes ranged from 10-42 mL. In patients with complete reperfusion, the intraclass correlation coefficient (ICC) showed moderate-good volumetric agreement (range 0.55-0.76). A poor agreement was found for all methods in patients with successful reperfusion (ICC range 0.36-0.45). Spatial agreement (median Dice) was low for all four methods (range 0.17-0.19). Severe core overestimation was most frequently (27%) seen in Method 3 and patients with carotid-T occlusion. Our study shows moderate-good volumetric agreement between ischemic core estimates for four different thresholds and subsequent infarct volume on DWI in EVT-treated patients with complete reperfusion. The spatial agreement was similar to other commercially available software packages.
计算机断层扫描灌注成像（CTP）常用于缺血性中风患者血管内血栓切除术（EVT）的分诊。我们旨在量化采用不同阈值估算的CTP缺血核心区的体积和空间一致性，以及后续磁共振成像（MRI）在扩散加权成像（DWI）上的梗死体积。纳入2017年11月至2020年9月期间接受EVT治疗且有可用基线CTP和后续DWI的患者。使用飞利浦IntelliSpace Portal软件，采用四种不同阈值处理数据。在DWI上分割后续梗死体积。55例患者中，DWI体积中位数为10 mL，CTP缺血核心区估计体积中位数为10 - 42 mL。在完全再灌注的患者中，组内相关系数（ICC）显示体积一致性为中度良好（范围0.55 - 0.76）。在成功再灌注的患者中，所有方法的一致性均较差（ICC范围0.36 - 0.45）。所有四种方法的空间一致性（中位数Dice）均较低（范围0.17 - 0.19）。在方法3和颈动脉T闭塞患者中，最常出现严重的核心区高估（27%）。我们的研究表明，在接受EVT治疗且完全再灌注的患者中，四种不同阈值估算的缺血核心区与后续DWI梗死体积之间的体积一致性为中度良好。空间一致性与其他商用软件包相似。
