Angiography suite cone-beam CT perfusion for selection of thrombectomy patients: A pilot study

Authors

Santiago Ortega-Gutierrez, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.
Darko Quispe-Orozco, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.
Sebastian Schafer, Imaging and Therapy Systems, Siemens Healthcare, Forchheim, Germany.
Mudassir Farooqui, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.
Cynthia B. Zevallos, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.
Sudeepta Dandapat, Advocate Aurora HealthFollow
Alan Mendez-Ruiz, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.
Beverly Aagaard-Kienitz, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.Follow
Nils Petersen, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
Colin P. Derdeyn, Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, Iowa, USA.

Recommended Citation

Ortega-Gutierrez S, Quispe-Orozco D, Schafer S, et al. Angiography suite cone-beam CT perfusion for selection of thrombectomy patients: A pilot study. J Neuroimaging. 2022;32(3):493-501. doi:10.1111/jon.12988

Affiliations

Aurora Neuroscience Innovation

Abstract

Background and purpose: The availability of cone-beam CT perfusion (CBCTP) in angiography suites may improve large-vessel occlusion (LVO) triage and reduce reperfusion times for patients presenting during extended time window. We aim to evaluate the perfusion maps correlation and agreement between multidetector CT perfusion (MDCTP) and CBCTP when obtained sequentially in patients undergoing endovascular therapy.

Methods: This is a prospective, pilot, single-arm interventional cohort study of consecutive patients with anterior circulation LVO. All patients underwent MDCTP and CBCTP prior to endovascular therapy, generating cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-maximum/time to peak contrast concentration maps. We compared the two imaging modalities using three different methods: (1) six regions of interest (ROIs) placed in the anterior circulation territory; (2) ROIs placed in all 10 Alberta Stroke Program Early CT Score regions; and (3) ROI drawn around the entire ischemic area. ROI ratios (unaffected/affected area) were compared for all sequences in each method. We used the intraclass correlation coefficient to calculate the correlation between the studies. Bland-Altman plots were also created to measure the degree of agreement. Finally, a sensitivity analysis was done comparing both modalities in patients with low infarct growth rate.

Results: Fourteen patients were included (median age 81 years [74-87], 50% males, median National Institutes of Health Stroke Scale 19 [14-22]). Median time between studies was 42 minutes (interquartile range 29-61). Independently of the method used, we found moderate to excellent correlation in CBF, CBV, and MTT between modalities. CBF correlation further improved in patients with low infarct growth.

Conclusion: These results demonstrate promising accuracy of CBCTP in evaluating ischemic tissue in patients presenting with LVO ischemic stroke.

Document Type

Article

PubMed ID

35315169