The correlation between CT perfusion deficits and immediate post-endovascular treatment contrast extravasation on dual energy CT in acute ischemic stroke patients.

Autor: Robbe MMQ; Department of Radiology and Nuclear Medicine, University Maastricht, Maastricht, the Netherlands; Maastricht University Medical Center, Maastricht, the Netherlands; School for Cardiovascular Disease (CARIM), University Maastricht, Maastricht, the Netherlands. Electronic address: quirien.robbe@mumc.nl., Pinckaers FME; Department of Radiology and Nuclear Medicine, University Maastricht, Maastricht, the Netherlands; Maastricht University Medical Center, Maastricht, the Netherlands; School for Cardiovascular Disease (CARIM), University Maastricht, Maastricht, the Netherlands., van Oostenbrugge RJ; Maastricht University Medical Center, Maastricht, the Netherlands; School for Cardiovascular Disease (CARIM), University Maastricht, Maastricht, the Netherlands; Department of Neurology, University Maastricht, Maastricht, the Netherlands., van Zwam WH; Department of Radiology and Nuclear Medicine, University Maastricht, Maastricht, the Netherlands; Maastricht University Medical Center, Maastricht, the Netherlands; School for Cardiovascular Disease (CARIM), University Maastricht, Maastricht, the Netherlands., Postma AA; Department of Radiology and Nuclear Medicine, University Maastricht, Maastricht, the Netherlands; Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), University Maastricht, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2024 Apr; Vol. 173, pp. 111379. Date of Electronic Publication: 2024 Feb 17.
DOI: 10.1016/j.ejrad.2024.111379
Abstrakt: Purpose: After endovascular therapy (EVT) for ischemic stroke, post-EVT CT imaging often shows areas of contrast extravasation (CE) caused by blood brain barrier disruption (BBBD). Before EVT, CT-perfusion (CTP) can be used to estimate salvageable tissue (penumbra) and irrevocably damaged infarction (core). In this study, we aimed to correlate CTP deficits to CE, as a surrogate marker for BBBD, after EVT for ischemic stroke.
Methods: In this single center study, EVT patients between 2010 and 2020 in whom both CTP at baseline and DECT post-EVT was performed were included. The presence of core and penumbra on CTP was assessed per ASPECTS region, resulting in a CTP-ASPECTS core and a CTP-ASPECTS core+penumbra . Likewise, CE on DECT was scored per ASPECTS region, resulting in a CE-ASPECTS. Correlation was assessed using Kendall's tau correlation and positive predictive values (PPV) were calculated per ASPECTS region. Bland-Altman plots were created to visualize the agreement between the two scores.
Results: 194 patients met our inclusion criteria. The median core and penumbra were 8 cc (IQR 1-25) and 103 cc (IQR 68-141), respectively. The median CTP-ASPECTS core , CTP-ASPECTS core+penumbra , and CE-ASPECTS were 7 (IQR 4-9), 3 (IQR 1-4), and 6 (IQR 4-9), respectively. The correlation between CTP-ASPECTS core and CE-ASPECTS was τ = 0.21, P <.001, and τ = 0.13, P =.02 between CTP-ASPECTS core+penumbra and CE-ASPECTS. Bland-Altman plots showed a mean difference (CTP-ASPECTS minus CE-ASPECTS) of 0.27 (95 %CI -6.7-7.2) for CTP-ASPECTS core and -3.2 (95 %CI -9.7-3.2) for CTP-ASPECTS core+penumbra . The PPVs of the CTP-ASPECTS core and CTP-ASPECTS core+penumbra were highest for the basal ganglia.
Conclusion: There is a weak although significant correlation between pre-EVT CTP-ASPECTS and post-EVT CE-ASPECTS. The weak correlation may be attributed to various imaging limitations as well as patient related factors.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: W.Z reports consulting fees from Philips, and speaker fees from Stryker, Cerenovus, and Nicolab (all paid to the institution). Moreover, he is participating in the Safety Monitoring Board or Advisory Board of WeTrust (Philips), InEcxtremis (CHU Montpellier), ANAIS (Anaconda), and DISTAL (University of Hospital Basal) studies. A.P received an institutional grant from Siemens Healthineers and Bayer Healthcare. Other co-authors have nothing to disclose.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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