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Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy—Comparison of Three Automated Perfusion Software Applications

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Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany
2
Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Benjamin M. Ellingson
Tomography 2022, 8(3), 1350-1362; https://doi.org/10.3390/tomography8030109
Received: 29 March 2022 / Revised: 6 May 2022 / Accepted: 12 May 2022 / Published: 17 May 2022
(This article belongs to the Section Brain Imaging)
Background: Innovative automated perfusion software solutions offer support in the management of acute stroke by providing information about the infarct core and penumbra. While the performance of different software solutions has mainly been investigated in patients with successful recanalization, the prognostic accuracy of the hypoperfusion maps in cases of futile recanalization has hardly been validated. Methods: In 39 patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation and poor revascularization (thrombolysis in cerebral infarction (TICI) 0-2a) after mechanical thrombectomy (MT), hypoperfusion analysis was performed using three different automated perfusion software solutions (A: RAPID, B: Brainomix e-CTP, C: Syngo.via). The hypoperfusion volumes (HV) as Tmax > 6 s were compared with the final infarct volumes (FIV) on follow-up CT 36–48 h after futile recanalization. Bland–Altman analysis was applied to display the levels of agreement and to evaluate systematic differences. Based on the median hypoperfusion intensity ratio (HIR, volumetric ratio of tissue with a Tmax > 10 s and Tmax > 6 s) patients were dichotomized into high- and low-HIR groups. Subgroup analysis with favorable (<0.6) and unfavorable (≥0.6) HIR was performed with respect to the FIV. HIR was correlated to clinical baseline and outcome parameters using Pearson’s correlation. Results: Overall, there was good correlation without significant differences between the HVs and the FIVs with package A (r = 0.78, p < 0.001) being slightly superior to B and C. However, levels of agreement were very wide for all software applications in Bland-Altman analysis. In cases of large infarcts exceeding 150 mL the performance of the automated software solutions generally decreased. Subgroup analysis revealed the FIV to be generally underestimated in patients with HIR ≥ 0.6 (p < 0.05). In the subgroup with favorable HIR, however, there was a trend towards an overestimation of the FIV. Nevertheless, packages A and B showed good correlation between the HVs and FIVs without significant differences (p > 0.2), while only package C significantly overestimated the FIV (−54.6 ± 56.0 mL, p = 0.001). The rate of modified Rankin Scale (mRS) 0–3 after 3 months was significantly higher in favorable vs. unfavorable HIR (42.1% vs. 13.3%, p = 0.02). Lower HIR was associated with higher Alberta Stroke Program Early CT Score (ASPECTS) at presentation and on follow-up imaging, lower risk of malignant edema, and better outcome (p < 0.05). Conclusion: Overall, the performance of the automated perfusion software solutions to predict the FIV after futile recanalization is good, with decreasing accuracy in large infarcts exceeding 150 mL. However, depending on the HIR, FIV can be significantly over- and underestimated, with Syngo showing the widest range. Our results indicate that the HIR can serve as valuable parameter for outcome predictions and facilitate the decision whether or not to perform MT in delicate cases. View Full-Text
Keywords: ischemic stroke; perfusion CT; automated CT perfusion software; artificial intelligence; mechanical thrombectomy ischemic stroke; perfusion CT; automated CT perfusion software; artificial intelligence; mechanical thrombectomy
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MDPI and ACS Style

Muehlen, I.; Borutta, M.; Siedler, G.; Engelhorn, T.; Hock, S.; Knott, M.; Hoelter, P.; Volbers, B.; Schwab, S.; Doerfler, A. Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy—Comparison of Three Automated Perfusion Software Applications. Tomography 2022, 8, 1350-1362. https://doi.org/10.3390/tomography8030109

AMA Style

Muehlen I, Borutta M, Siedler G, Engelhorn T, Hock S, Knott M, Hoelter P, Volbers B, Schwab S, Doerfler A. Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy—Comparison of Three Automated Perfusion Software Applications. Tomography. 2022; 8(3):1350-1362. https://doi.org/10.3390/tomography8030109

Chicago/Turabian Style

Muehlen, Iris, Matthias Borutta, Gabriela Siedler, Tobias Engelhorn, Stefan Hock, Michael Knott, Philip Hoelter, Bastian Volbers, Stefan Schwab, and Arnd Doerfler. 2022. "Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy—Comparison of Three Automated Perfusion Software Applications" Tomography 8, no. 3: 1350-1362. https://doi.org/10.3390/tomography8030109

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