Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID
Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID
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DOI：
10.1136/neurintsurg-2020-015966
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发表时间：
2021-02-01
影响因子：
4.8
通讯作者：
Ionita, Ciprian N.
中科院分区：
文献类型：
--
作者：
Rava, Ryan A.;Snyder, Kenneth, V;Ionita, Ciprian N.
CT灌注(CTP)、梗塞和半影区的评估决定了急性缺血性中风(AIS)患者是否有资格接受血管内介入治疗。本研究旨在确定预测的快速、Vitrea和球形CTP梗塞与后续液体衰减反转恢复(FLAIR)MRI梗塞的体积和空间一致性。方法自2019年4月至2020年1月，连续108例AIS合并大血管闭塞患者纳入研究。患者分为血管内介入治疗组(58例)和保守治疗组(50例)。干预组患者行机械取栓术，成功再通(脑梗塞2b/2c/3)，保守治疗组未行机械取栓术或静脉溶栓治疗。介入治疗和保守治疗患者分别用于评估梗塞和半暗带的估计。据推测，在所有保守治疗的患者中，半影区转变为梗死灶。结果每组CTP软件与FLAIR MRI的平均梗塞面积差值(95%CI)分别为：干预队列：快速=9.0+/-7.7m L，球体=-0.2+/-8.7m L，玻璃体=-7.9+/-8.9m L；保守治疗队列：快速=-31.9+/-21.6m L，球体=-26.8+/-17.4m L，玻璃体=-15.3+/-13.7m L。预测梗塞的重叠系数和骰子系数分别为：干预队列：快速=(0.57，0.44)，球形=(0.68，0.60)，Vitrea=(0.70，0.60)；保守治疗队列：快速=(0.71，0.56)，球形=(0.73，0.60)，Vitrea=(0.72，0.64)。尽管所有软件都高估了半暗带，但在保守治疗的患者中，Vitrea被证明是最准确的半暗带评估。
BackgroundCT perfusion (CTP) infarct and penumbra estimations determine the eligibility of patients with acute ischemic stroke (AIS) for endovascular intervention. This study aimed to determine volumetric and spatial agreement of predicted RAPID, Vitrea, and Sphere CTP infarct with follow-up fluid attenuation inversion recovery (FLAIR) MRI infarct.Methods108 consecutive patients with AIS and large vessel occlusion were included in the study between April 2019 and January 2020 . Patients were divided into two groups: endovascular intervention (n=58) and conservative treatment (n=50). Intervention patients were treated with mechanical thrombectomy and achieved successful reperfusion (Thrombolysis in Cerebral Infarction 2b/2 c/3) while patients in the conservative treatment group did not receive mechanical thrombectomy or intravenous thrombolysis. Intervention and conservative treatment patients were included to assess infarct and penumbra estimations, respectively. It was assumed that in all patients treated conservatively, penumbra converted to infarct. CTP infarct and penumbra volumes were segmented from RAPID, Vitrea, and Sphere to assess volumetric and spatial agreement with follow-up FLAIR MRI.ResultsMean infarct differences (95% CIs) between each CTP software and FLAIR MRI for each cohort were: intervention cohort: RAPID=9.0 +/- 7.7 mL, Sphere=-0.2 +/- 8.7 mL, Vitrea=-7.9 +/- 8.9 mL; conservative treatment cohort: RAPID=-31.9 +/- 21.6 mL, Sphere=-26.8 +/- 17.4 mL, Vitrea=-15.3 +/- 13.7 mL. Overlap and Dice coefficients for predicted infarct were (overlap, Dice): intervention cohort: RAPID=(0.57, 0.44), Sphere=(0.68, 0.60), Vitrea=(0.70, 0.60); conservative treatment cohort: RAPID=(0.71, 0.56), Sphere=(0.73, 0.60), Vitrea=(0.72, 0.64).ConclusionsSphere proved the most accurate in patients who had intervention infarct assessment as Vitrea and RAPID overestimated and underestimated infarct, respectively. Vitrea proved the most accurate in penumbra assessment for patients treated conservatively although all software overestimated penumbra.