Accuracy of “At Risk” Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions

for the MR CLEAN Investigators, Songmi Lee, Albert J. Yoo, Henk A. Marquering, Olvert A. Berkhemer, Charles B. Majoie, Diederik W.J. Dippel, Sunil A Sheth

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: The validity of CT perfusion (CTP) predictions of expected infarction volume (“at risk” tissue) without rapid recanalization remains poorly characterized. METHODS: From the MR CLEAN trial, we included patients who underwent CTP without successful recanalization. “At risk” volume was defined as Tmax > 6 seconds and ischemic core as relative CBF < 30 (Olea Sphere). Coprimary outcomes were follow-up infarct volume (FIV) on CT at 1-5 days and 90-day mRS. Data are presented as median [IQR] or OR [95% CI] unless otherwise specified. RESULTS: Among 37 patients who met criteria, 14 (38%) were women, median age was 61 years [52-69], NIHSS was 19 [15-21], ASPECTS was 8 [7-9], and onset to imaging was 160 minutes [39-200]. Occlusion location was M1 for 22 (59%), ICA-T in 10 (27%), and M2 in 4 (11%). In univariable analysis, “at risk” volume correlated poorly with FIV (r =.06, P =.77). Among patients with predicted “at risk” volume < 100 mL, 36% had FIV > 200 mL. In adjusted linear regression, NIHSS but not “at risk” volume was associated with FIV (Coef 12, P =.045; Coef –.15, P =.8). In adjusted logistic regression, NIHSS but not “at risk” volume was associated with mRS 0-2 at 90 days (OR.7 [.5-.99]; OR 1.0 [.99-1.04]). CONCLUSION: Predictions of “at-risk” tissue using CTP may underestimate the natural history of infarction from acute large vessel occlusions. NIHSS may perform better as a predictor of clinical outcomes in patients without rapid recanalization.

LanguageEnglish
JournalJournal of Neuroimaging
DOIs
StateAccepted/In press - Jan 1 2019

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Perfusion
Infarction
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Linear Models
Logistic Models

Keywords

  • CT Perfusion
  • endovascular treatment
  • stroke
  • “at risk” tissue

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Accuracy of “At Risk” Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions. / for the MR CLEAN Investigators.

In: Journal of Neuroimaging, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND PURPOSE: The validity of CT perfusion (CTP) predictions of expected infarction volume (“at risk” tissue) without rapid recanalization remains poorly characterized. METHODS: From the MR CLEAN trial, we included patients who underwent CTP without successful recanalization. “At risk” volume was defined as Tmax > 6 seconds and ischemic core as relative CBF < 30 (Olea Sphere). Coprimary outcomes were follow-up infarct volume (FIV) on CT at 1-5 days and 90-day mRS. Data are presented as median [IQR] or OR [95{\%} CI] unless otherwise specified. RESULTS: Among 37 patients who met criteria, 14 (38{\%}) were women, median age was 61 years [52-69], NIHSS was 19 [15-21], ASPECTS was 8 [7-9], and onset to imaging was 160 minutes [39-200]. Occlusion location was M1 for 22 (59{\%}), ICA-T in 10 (27{\%}), and M2 in 4 (11{\%}). In univariable analysis, “at risk” volume correlated poorly with FIV (r =.06, P =.77). Among patients with predicted “at risk” volume < 100 mL, 36{\%} had FIV > 200 mL. In adjusted linear regression, NIHSS but not “at risk” volume was associated with FIV (Coef 12, P =.045; Coef –.15, P =.8). In adjusted logistic regression, NIHSS but not “at risk” volume was associated with mRS 0-2 at 90 days (OR.7 [.5-.99]; OR 1.0 [.99-1.04]). CONCLUSION: Predictions of “at-risk” tissue using CTP may underestimate the natural history of infarction from acute large vessel occlusions. NIHSS may perform better as a predictor of clinical outcomes in patients without rapid recanalization.",
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AU - Lee, Songmi

AU - Yoo, Albert J.

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AU - Berkhemer, Olvert A.

AU - Majoie, Charles B.

AU - Dippel, Diederik W.J.

AU - Sheth, Sunil A

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