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Original research
Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect
  1. A M M Boers1,2,3,
  2. O A Berkhemer1,4,
  3. C H Slump2,
  4. W H van Zwam5,
  5. Y B W E M Roos6,
  6. A van der Lugt7,
  7. R J van Oostenbrugge8,
  8. A J Yoo9,
  9. D W J Dippel4,
  10. H A Marquering1,3,
  11. C B L M Majoie1
  12. on behalf of the MR CLEAN trial investigators
    1. 1Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
    2. 2Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
    3. 3Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
    4. 4Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
    5. 5Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
    6. 6Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
    7. 7Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
    8. 8Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
    9. 9Division of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
    1. Correspondence to Anna M M Boers, Department of Biomedical Engineering and Physics, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands; a.m.boers{at}amc.uva.nl

    Abstract

    Background Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance.

    Objective To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type.

    Methods Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions.

    Results The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct.

    Conclusions Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment.

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