Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra
Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra
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DOI：
10.1148/radiol.12120971
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发表时间：
2013-05-01
期刊：
影响因子：
19.7
通讯作者：
Parsons, Mark
中科院分区：
文献类型：
--
作者：
Bivard, Andrew;Levi, Christopher;Parsons, Mark
目的：对所有常用的灌注计算机断层扫描（CT）数据后处理方法在急性脑卒中梗死核心和半暗区定义中的准确性进行大规模系统比较。材料和方法：本研究的数据收集经机构伦理委员会批准，所有患者均给予知情同意。314例脑半球缺血患者在出现脑卒中症状的6小时内接受灌注CT检查，并在24小时内接受磁共振成像检查。采用6种不同的后处理方法生成CT灌注图。采用基于像素的分析方法计算各后处理方法不同灌注CT阈值对半暗带和梗死核心的敏感性和特异性，绘制受试者操作特征（ROC）曲线。采用ROC曲线下面积（AUC）分析确定最佳阈值。结果：延迟校正的SVD （delay -corrected singular value deconvolution，延迟时间大于2秒）最准确地定义了半暗带（AUC = 0.86, P = 0.046，急性灌注CT与24小时弥散加权MR成像的平均体积差= 1.7 mL）。延迟时间大于2秒且脑血流量小于40%的双核心阈值提供了最准确的梗死核心定义（AUC = 0.86, P = 0.038）。其他SVD测量（块循环，非延迟校正）比非SVD方法更准确。结论：本研究表明，各种反卷积技术在半暗区和梗死预测方面存在明显的可变性，并强调了卒中灌注CT标准化的必要性。(c) rsna, 2013
Purpose: To perform a large-scale systematic comparison of the accuracy of all commonly used perfusion computed tomography (CT) data postprocessing methods in the definition of infarct core and penumbra in acute stroke.Materials and Methods: The collection of data for this study was approved by the institutional ethics committee, and all patients gave informed consent. Three hundred fourteen patients with hemispheric ischemia underwent perfusion CT within 6 hours of stroke symptom onset and magnetic resonance (MR) imaging at 24 hours. CT perfusion maps were generated by using six different postprocessing methods. Pixel-based analysis was used to calculate sensitivity and specificity of different perfusion CT thresholds for the penumbra and infarct core with each postprocessing method, and receiver operator characteristic (ROC) curves were plotted. Area under the ROC curve (AUC) analysis was used to define the optimum threshold.Results: Delay-corrected singular value deconvolution (SVD) with a delay time of more than 2 seconds most accurately defined the penumbra (AUC = 0.86, P = .046, mean volume difference between acute perfusion CT and 24-hour diffusion-weighted MR imaging = 1.7 mL). A double core threshold with a delay time of more than 2 seconds and cerebral blood flow less than 40% provided the most accurate definition of the infarct core (AUC = 0.86, P = .038). The other SVD measures (block circulant, nondelay corrected) were more accurate than non-SVD methods.Conclusion: This study has shown that there is marked variability in penumbra and infarct prediction among various deconvolution techniques and highlights the need for standardization of perfusion CT in stroke. (C) RSNA, 2013