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Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging

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Abstract

Objectives

To compare ischaemic lesions predicted by different CT perfusion (CTP) post-processing techniques and validate CTP lesions compared with final lesion size in stroke patients.

Methods

Fifty patients underwent CT, CTP and CT angiography. Quantitative values and colour maps were calculated using least mean square deconvolution (LMSD), maximum slope (MS) and conventional singular value decomposition deconvolution (SVDD) algorithms. Quantitative results, core/penumbra lesion sizes and Alberta Stroke Programme Early CT Score (ASPECTS) were compared among the algorithms; lesion sizes and ASPECTS were compared with final lesions on follow-up MRI + MRA or CT + CTA as a reference standard, accounting for recanalisation status.

Results

Differences in quantitative values and lesion sizes were statistically significant, but therapeutic decisions based on ASPECTS and core/penumbra ratios would have been the same in all cases. CTP lesion sizes were highly predictive of final infarct size: Coefficients of determination (R 2) for CTP versus follow-up lesion sizes in the recanalisation group were 0.87, 0.82 and 0.61 (P < 0.001) for LMSD, MS and SVDD, respectively, and 0.88, 0.87 and 0.76 (P < 0.001), respectively, in the non-recanalisation group.

Conclusions

Lesions on CT perfusion are highly predictive of final infarct. Different CTP post-processing algorithms usually lead to the same clinical decision, but for assessing lesion size, LMSD and MS appear superior to SVDD.

Key Points

• Following an acute stroke, CT perfusion imaging can help predict lesion evolution.

• Delay-insensitive deconvolution and maximum slope approach are superior to delay-sensitive deconvolution regarding accuracy.

• Different CT perfusion post-processing algorithms usually lead to the same clinical decision.

• CT perfusion offers new insights into the evolution of stroke.

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Abbreviations

ASPECTS:

Alberta Stroke Programme Early CT Score

CBF:

cerebral blood flow

CBV:

cerebral blood volume

CTA:

CT angiography

CTP:

CT perfusion

DC:

deconvolution

DWI:

diffusion-weighted imaging

FLAIR:

fluid attenuation inversion recovery

LMSD:

least mean square deconvolution

MIP:

maximum intensity projection

MRS:

modified Rankin scale

MS:

maximum slope

MTT:

mean transit time

NIHSS:

National Institutes of Health Stroke Scale

NPV:

negative predictive value

NVT:

non-viable tissue

PPV:

positive predictive value

PWI:

perfusion-weighted imaging

SVDD:

singular value decomposition deconvolution

STARD:

Standards for Reporting of Diagnostic Accuracy Studies

TAR:

tissue at risk

ToF-MRA:

time-of-flight MR angiography

TTD:

time to drain

TTP:

time to peak

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Authors and Affiliations

  1. Institute of Radiology, University Hospital Erlangen, Erlangen, Germany

    Benjamin Abels, Michael Uder & Michael M. Lell

  2. Department of Neuroradiology, UCLA Medical Center, Los Angeles, CA, USA

    J. Pablo Villablanca

  3. Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany

    Bernd F. Tomandl

  4. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Benjamin Abels

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  1. Benjamin Abels
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  2. J. Pablo Villablanca
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  3. Bernd F. Tomandl
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  4. Michael Uder
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  5. Michael M. Lell
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Correspondence to Benjamin Abels.

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Abels, B., Villablanca, J.P., Tomandl, B.F. et al. Acute stroke: a comparison of different CT perfusion algorithms and validation of ischaemic lesions by follow-up imaging. Eur Radiol 22, 2559–2567 (2012). https://doi.org/10.1007/s00330-012-2529-8

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  • DOI: https://doi.org/10.1007/s00330-012-2529-8

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