Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke

Christopher D d'Esterre; Anurag Trivedi; Pooneh Pordeli; Mari Boesen; Shivanand Patil; Seong Hwan Ahn; Mohamed Najm; Enrico Fainardi; Jai Jai Shiva Shankar; Marta Rubiera; Mohammed A Almekhlafi; Jennifer Mandzia; Alexander V Khaw; Philip Barber; Shelagh Coutts; Michael D Hill; Andrew M Demchuk; Tolulope Sajobi; Nils D Forkert; Mayank Goyal; Ting-Yim Lee; Bijoy K Menon

doi:10.1161/STROKEAHA.116.015969

Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke

Stroke. 2017 Apr;48(4):939-945. doi: 10.1161/STROKEAHA.116.015969. Epub 2017 Mar 14.

Authors

Christopher D d'Esterre¹, Anurag Trivedi¹, Pooneh Pordeli¹, Mari Boesen¹, Shivanand Patil¹, Seong Hwan Ahn¹, Mohamed Najm¹, Enrico Fainardi¹, Jai Jai Shiva Shankar¹, Marta Rubiera¹, Mohammed A Almekhlafi¹, Jennifer Mandzia¹, Alexander V Khaw¹, Philip Barber¹, Shelagh Coutts¹, Michael D Hill¹, Andrew M Demchuk¹, Tolulope Sajobi¹, Nils D Forkert¹, Mayank Goyal¹, Ting-Yim Lee¹, Bijoy K Menon²

Affiliations

¹ From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., M.B., S.P., M.N., P.B., S.C., M.D.H., A.M.D., T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., M.D.H., N.D.F., M.G., T.-Y.L.), Department of Community Health Sciences (P.P., M.D.H., T.S.), and Hotchkiss Brain Institute (P.B., S.C., M.D.H., A.M.D., M.G.), University of Calgary, AB; Seaman Family Center, Calgary, Alberta (C.D.d'E., M.N., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Vancouver Island Health, Victoria, BC (A.T.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Diagnostic Imaging, University Hospital, Florence, Italy (E.F.); Department of Neurology, Neuroradiology, Dalhousie University, Halifax, Nova Scotia (J.J.S.S.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurology, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Clinical Neurosciences, University of Western Ontario, London (J.M., A.V.K.); and Lawson Health Research Institute and Robarts Research Institute, London, ON (A.V.K., T.-Y.L.).
² From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., M.B., S.P., M.N., P.B., S.C., M.D.H., A.M.D., T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., M.D.H., N.D.F., M.G., T.-Y.L.), Department of Community Health Sciences (P.P., M.D.H., T.S.), and Hotchkiss Brain Institute (P.B., S.C., M.D.H., A.M.D., M.G.), University of Calgary, AB; Seaman Family Center, Calgary, Alberta (C.D.d'E., M.N., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Vancouver Island Health, Victoria, BC (A.T.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Diagnostic Imaging, University Hospital, Florence, Italy (E.F.); Department of Neurology, Neuroradiology, Dalhousie University, Halifax, Nova Scotia (J.J.S.S.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurology, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Clinical Neurosciences, University of Western Ontario, London (J.M., A.V.K.); and Lawson Health Research Institute and Robarts Research Institute, London, ON (A.V.K., T.-Y.L.). docbijoymenon@gmail.com.

PMID: 28292870
DOI: 10.1161/STROKEAHA.116.015969

Abstract

Background and purpose: Within different brain regions, we determine the comparative value of multiphase computed tomographic angiography (mCTA) and computed tomographic perfusion (CTP) in predicting follow-up infarction.

Methods: Patients with M1-middle cerebral artery occlusions were prospectively included in this multicenter study. Regional analysis was performed for each patient within Alberta Stroke Program Early CT Score regions M2 to M6. Regional pial vessel filling was assessed on mCTA in 3 ways: (1) Washout of contrast within pial vessels; (2) Extent of maximal pial vessel enhancement compared with contralateral hemisphere; (3) Delay in maximal pial vessel enhancement compared with contralateral hemisphere. Cerebral blood flow, cerebral blood volume, and Tmax data were extracted within these Alberta Stroke Program Early CT Score regions. Twenty-four- to 36-hour magnetic resonance imaging/CT was assessed for infarct in each Alberta Stroke Program Early CT Score region (defined as >20% infarction within that region). Mixed effects logistic regression models were used to compare mCTA and CTP parameters when predicting brain infarction. Area under the receiver operating characteristics was used to assess discriminative value of statistical models.

Results: Seventy-seven patients were included. mCTA parameter washout and CTP parameter Tmax were significantly associated with follow-up infarction in all models (P<0.05). The area under the receiver operating characteristic for mCTA models ranged from 92% to 94% and was not different compared with all CTP models (P>0.05). Mean Tmax and cerebral blood volume values were significantly different between each washout score (P<0.01) and each delay score category (P<0.01). Mean Tmax, cerebral blood flow, and cerebral blood volume values were significantly different between each extent score category (P<0.05).

Conclusions: Similar to CTP, multiphase CTA can be used to predict tissue fate regionally in acute ischemic stroke patients.

Keywords: infarction; logistic models; magnetic resonance imaging; stroke; tomography.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia / diagnostic imaging*
Cerebral Angiography / methods
Computed Tomography Angiography / methods
Female
Humans
Infarction, Middle Cerebral Artery / diagnostic imaging*
Male
Middle Aged
Outcome Assessment, Health Care*
Perfusion Imaging / methods
Prognosis
Prospective Studies
Stroke / diagnostic imaging*
Tomography, X-Ray Computed / methods*

Grants and funding

CIHR/Canada