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Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties.

作者信息

Fainardi Enrico, Busto Giorgio, Morotti Andrea

机构信息

Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy.

Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.

出版信息

Eur J Radiol Open. 2023 Sep 20;11:100524. doi: 10.1016/j.ejro.2023.100524. eCollection 2023 Dec.


DOI:10.1016/j.ejro.2023.100524
PMID:37771657
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10523426/
Abstract

The purpose of this is study was to review pearls and pitfalls of advanced imaging, such as computed tomography perfusion and diffusion-weighed imaging and perfusion-weighted imaging in the selection of acute ischemic stroke (AIS) patients suitable for endovascular treatment (EVT) in the late time window (6-24 h from symptom onset). Advanced imaging can quantify infarct core and ischemic penumbra using specific threshold values and provides optimal selection parameters, collectively called target mismatch. More precisely, target mismatch criteria consist of core volume and/or penumbra volume and mismatch ratio (the ratio between total hypoperfusion and core volumes) with precise cut-off values. The parameters of target mismatch are automatically calculated with dedicated software packages that allow a quick and standardized interpretation of advanced imaging. However, this approach has several limitations leading to a misclassification of core and penumbra volumes. In fact, automatic software platforms are affected by technical artifacts and are not interchangeable due to a remarkable vendor-dependent variability, resulting in different estimate of target mismatch parameters. In addition, advanced imaging is not completely accurate in detecting infarct core, that can be under- or overestimated. Finally, the selection of candidates for EVT remains currently suboptimal due to the high rates of futile reperfusion and overselection caused by the use of very stringent inclusion criteria. For these reasons, some investigators recently proposed to replace advanced with conventional imaging in the selection for EVT, after the demonstration that non-contrast CT ASPECTS and computed tomography angiography collateral evaluation are not inferior to advanced images in predicting outcome in AIS patients treated with EVT. However, other authors confirmed that CTP and PWI/DWI postprocessed images are superior to conventional imaging in establishing the eligibility of patients for EVT. Therefore, the routine application of automatic assessment of advanced imaging remains a matter of debate. Recent findings suggest that the combination of conventional and advanced imaging might improving our selection criteria.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/cafe1359cc68/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/b1e6d0431e75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/dcab5f6468bd/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/bcaec02c1bec/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/b89ae39dfc9f/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/a511d7fc0a49/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/c88c38bfa2eb/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/f0c416ba5f8c/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/cafe1359cc68/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/b1e6d0431e75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/dcab5f6468bd/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/bcaec02c1bec/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/b89ae39dfc9f/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/a511d7fc0a49/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/c88c38bfa2eb/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/f0c416ba5f8c/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0805/10523426/cafe1359cc68/gr8.jpg

相似文献

[1]
Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties.

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[2]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Target mismatch criteria in acute ischemic stroke patients with distal-medium vessel occlusion.

Eur Stroke J. 2025-8-11

[2]
Quantitative Evaluation of Ischemic Core Volume in GE's CT Perfusion Imaging Analysis Software and Its Relationship to Alberta Stroke Program Early CT Score.

J Neuroendovasc Ther. 2025

[3]
Current Stroke Solutions Using Artificial Intelligence: A Review of the Literature.

Brain Sci. 2024-11-26

本文引用的文献

[1]
Pivotal role of multiphase computed tomography angiography for collateral assessment in patients with acute ischemic stroke.

Radiol Med. 2023-8

[2]
Perfusion Imaging Mismatch Profiles in the Early Thrombectomy Window: A Single-Center Analysis.

Stroke. 2023-5

[3]
Comparative analysis of core and perfusion lesion volumes between commercially available computed tomography perfusion software.

Eur Stroke J. 2023-3

[4]
Endovascular treatment versus no endovascular treatment after 6-24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial.

Lancet. 2023-4-22

[5]
CT Perfusion vs Noncontrast CT for Late Window Stroke Thrombectomy: A Systematic Review and Meta-analysis.

Neurology. 2023-5-30

[6]
Thrombolysis for acute ischaemic stroke: current status and future perspectives.

Lancet Neurol. 2023-5

[7]
Core overestimation of CT perfusion in patients with cardiac insufficiency who had a stroke is mediated by impaired collaterals.

J Neurointerv Surg. 2023-12-19

[8]
Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke.

Neuroradiology. 2023-6

[9]
Trial of Endovascular Thrombectomy for Large Ischemic Strokes.

N Engl J Med. 2023-4-6

[10]
Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct.

N Engl J Med. 2023-4-6

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