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Original research
What is the impact of head movement on automated CT perfusion mismatch evaluation in acute ischemic stroke?
  1. Arne Potreck,
  2. Fatih Seker,
  3. Matthias Anthony Mutke,
  4. Charlotte Sabine Weyland,
  5. Christian Herweh,
  6. Sabine Heiland,
  7. Martin Bendszus,
  8. Markus Möhlenbruch
  1. Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Arne Potreck, Department of Neuroradiology, University Hospital Heidelberg, Heidelberg 69120, Germany; arne.potreck{at}med.uni-heidelberg.de

Abstract

Objectives Automated CT perfusion mismatch assessment is an established treatment decision tool in acute ischemic stroke. However, the reliability of this method in patients with head motion is unclear. We therefore sought to evaluate the influence of head movement on automated CT perfusion mismatch evaluation.

Methods Using a realistic CT brain-perfusion-phantom, 7 perfusion mismatch scenarios were simulated within the left middle cerebral artery territory. Real CT noise and artificial head movement were added. Thereafter, ischemic core, penumbra volumes and mismatch ratios were evaluated using an automated mismatch analysis software (RAPID, iSchemaView) and compared with ground truth simulated values.

Results While CT scanner noise alone had only a minor impact on mismatch evaluation, a tendency towards smaller infarct core estimates (mean difference of −5.3 (−14 to 3.5) mL for subtle head movement and −7.0 (−14.7 to 0.7) mL for strong head movement), larger penumbral estimates (+9.9 (−25 to 44) mL and +35 (−14 to 85) mL, respectively) and consequently larger mismatch ratios (+0.8 (−1.5 to 3.0) for subtle head movement and +1.9 (−1.3 to 5.1) for strong head movement) were noted in dependence of patient head movement.

Conclusions Motion during CT perfusion acquisition influences automated mismatch evaluation. Potentially treatment-relevant changes in mismatch classifications in dependence of head movement were observed and occurred in favor of mechanical thrombectomy.

  • CT
  • stroke
  • CT perfusion
  • thrombectomy

Data availability statement

The datasets generated and/or analyzed during this research are available from the corresponding author upon reasonable request.

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Data availability statement

The datasets generated and/or analyzed during this research are available from the corresponding author upon reasonable request.

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Footnotes

  • Contributors AP, MB, SH and MMö initiated the project. AP led the research, conducted the simulations, data acquisition, statistical analysis and wrote the manuscript. MB, SH, MMö were involved in the study design and concept. FS, CW, MMu, CH assisted data acquisition. All authors discussed the results, commented on the paper, and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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