PLoS ONE (Jan 2015)

Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke.

  • Ralph R E G Geuskens,
  • Jordi Borst,
  • Marit Lucas,
  • A M Merel Boers,
  • Olvert A Berkhemer,
  • Yvo B W E M Roos,
  • Marianne A A van Walderveen,
  • Sjoerd F M Jenniskens,
  • Wim H van Zwam,
  • Diederik W J Dippel,
  • Charles B L M Majoie,
  • Henk A Marquering,
  • MR CLEAN trial investigators(www.mrclean-trial.org)

DOI
https://doi.org/10.1371/journal.pone.0141571
Journal volume & issue
Vol. 10, no. 11
p. e0141571

Abstract

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BackgroundCT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up.Materials and methodsThis study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0). Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBVResultsMedian total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml); median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml). Median FDR between patients was 62% (IQR:49%-80%). Median relative mean transit time was 243% (IQR:198%-289%) and 342% (IQR:249%-432%) for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43-1.79) ml/100g (PConclusionFor all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly differed between ischemic lesion agreement and misclassified CTP ischemic core, suggesting that CTP analysis may benefit from revisions.