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 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

581 Scopus citations

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 1 2006

Keywords

  • Computed tomography
  • Perfusion
  • ROC analysis
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Wintermark, M., Flanders, A. E., Velthuis, B., Meuli, R., Van Leeuwen, M., Goldsher, D., Pineda, C., Serena, J., Van Der Schaaf, I., Waaijer, A., Anderson, J., Nesbit, G., Gabriely, I., Medina, V., Quiles, A., Pohlman, S., Quist, M., Schnyder, P., Bogousslavsky, J., ... 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, 37(4), 979-985. https://doi.org/10.1161/01.STR.0000209238.61459.39