Perfusion-CT assessment of infarct core and penumbra: Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke

Max Wintermark, Adam E. Flanders, Birgitta Velthuis, Reto Meuli, Maarten Van Leeuwen, Dorit Goldsher, Carissa Pineda, Joaquin Serena, Irene Van Der Schaaf, Annet Waaijer, James (Jim) Anderson, Gary Nesbit, Igal Gabriely, Victoria Medina, Ana Quiles, Scott Pohlman, Marcel Quist, Pierre Schnyder, Julien Bogousslavsky, William P. DillonSalvador Pedraza

Research output: Contribution to journalArticle

551 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)979-985
Number of pages7
JournalStroke
Volume37
Issue number4
DOIs
StatePublished - Apr 2006

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Cerebrovascular Circulation
ROC Curve
Perfusion
Stroke
Area Under Curve
Infarction
Multicenter Studies
Cerebral Blood Volume

Keywords

  • Computed tomography
  • Perfusion
  • ROC analysis
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Perfusion-CT assessment of infarct core and penumbra : Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. / Wintermark, Max; Flanders, Adam E.; Velthuis, Birgitta; Meuli, Reto; Van Leeuwen, Maarten; Goldsher, Dorit; Pineda, Carissa; Serena, Joaquin; Van Der Schaaf, Irene; Waaijer, Annet; Anderson, James (Jim); Nesbit, Gary; Gabriely, Igal; Medina, Victoria; Quiles, Ana; Pohlman, Scott; Quist, Marcel; Schnyder, Pierre; Bogousslavsky, Julien; Dillon, William P.; Pedraza, Salvador.

In: Stroke, Vol. 37, No. 4, 04.2006, p. 979-985.

Research output: Contribution to journalArticle

Wintermark, M, Flanders, AE, Velthuis, B, Meuli, R, Van Leeuwen, M, Goldsher, D, Pineda, C, Serena, J, Van Der Schaaf, I, Waaijer, A, Anderson, JJ, Nesbit, G, Gabriely, I, Medina, V, Quiles, A, Pohlman, S, Quist, M, Schnyder, P, Bogousslavsky, J, Dillon, WP & Pedraza, S 2006, 'Perfusion-CT assessment of infarct core and penumbra: Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke', Stroke, vol. 37, no. 4, pp. 979-985. https://doi.org/10.1161/01.STR.0000209238.61459.39
Wintermark, Max ; Flanders, Adam E. ; Velthuis, Birgitta ; Meuli, Reto ; Van Leeuwen, Maarten ; Goldsher, Dorit ; Pineda, Carissa ; Serena, Joaquin ; Van Der Schaaf, Irene ; Waaijer, Annet ; Anderson, James (Jim) ; Nesbit, Gary ; Gabriely, Igal ; Medina, Victoria ; Quiles, Ana ; Pohlman, Scott ; Quist, Marcel ; Schnyder, Pierre ; Bogousslavsky, Julien ; Dillon, William P. ; Pedraza, Salvador. / Perfusion-CT assessment of infarct core and penumbra : Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. In: Stroke. 2006 ; Vol. 37, No. 4. pp. 979-985.
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abstract = "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.",
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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 (Jim)

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

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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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