TY - JOUR
T1 - Perfusion-CT assessment of infarct core and penumbra
T2 - Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke
AU - Wintermark, Max
AU - Flanders, Adam E.
AU - Velthuis, Birgitta
AU - Meuli, Reto
AU - Van Leeuwen, Maarten
AU - Goldsher, Dorit
AU - Pineda, Carissa
AU - Serena, Joaquin
AU - Van Der Schaaf, Irene
AU - Waaijer, Annet
AU - Anderson, James
AU - Nesbit, Gary
AU - Gabriely, Igal
AU - Medina, Victoria
AU - Quiles, Ana
AU - Pohlman, Scott
AU - Quist, Marcel
AU - Schnyder, Pierre
AU - Bogousslavsky, Julien
AU - Dillon, William P.
AU - Pedraza, Salvador
PY - 2006/4
Y1 - 2006/4
N2 - Background and Purpose - Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. Methods - One hundred and thirty patients with symptoms suggesting hemispheric stroke ≤12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performed to determine the most accurate PCT parameter, and the optimal threshold for each parameter, using DWI/FLAIR as the gold standard. Results - The PCT parameter that most accurately describes the tissue at risk of infarction in case of persistent arterial occlusion is the relative MTT (area under the curve=0.962), with an optimal threshold of 145%. The PCT parameter that most accurately describes the infarct core on admission is the absolute CBV (area under the curve=0.927), with an optimal threshold at 2.0 ml×100 g-1. Conclusion - In a large series of 130 patients, the optimal approach to define the infarct and the penumbra is a combined approach using 2 PCT parameters: relative MTT and absolute CBV, with dedicated thresholds.
AB - Background and Purpose - Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. Methods - One hundred and thirty patients with symptoms suggesting hemispheric stroke ≤12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performed to determine the most accurate PCT parameter, and the optimal threshold for each parameter, using DWI/FLAIR as the gold standard. Results - The PCT parameter that most accurately describes the tissue at risk of infarction in case of persistent arterial occlusion is the relative MTT (area under the curve=0.962), with an optimal threshold of 145%. The PCT parameter that most accurately describes the infarct core on admission is the absolute CBV (area under the curve=0.927), with an optimal threshold at 2.0 ml×100 g-1. Conclusion - In a large series of 130 patients, the optimal approach to define the infarct and the penumbra is a combined approach using 2 PCT parameters: relative MTT and absolute CBV, with dedicated thresholds.
KW - Computed tomography
KW - Perfusion
KW - ROC analysis
KW - Stroke
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U2 - 10.1161/01.STR.0000209238.61459.39
DO - 10.1161/01.STR.0000209238.61459.39
M3 - Article
C2 - 16514093
AN - SCOPUS:33645817175
SN - 0039-2499
VL - 37
SP - 979
EP - 985
JO - Stroke
JF - Stroke
IS - 4
ER -