TY - JOUR
T1 - Effect of extended CT perfusion acquisition time on ischemic core and penumbra volume estimation in patients with acute ischemic stroke due to a large vessel occlusion
AU - Borst, Jordi
AU - Marquering, Henk A.
AU - Beenen, Ludo F. M.
AU - Berkhemer, Olvert A.
AU - Dankbaar, Jan Willem
AU - Riordan, Alan J.
AU - Majoie, Charles B. L. M.
AU - AUTHOR GROUP
AU - Dippel, Diederik W.
AU - Brouwer, Patrick A.
AU - Roos, Yvo B.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Boiten, Jelis
AU - Lycklama à Nijeholt, Geert J.
AU - Wermer, Marieke J.
AU - van Walderveen, Marianne A.
AU - Kappelle, L. Jaap
AU - Lo, Rob T.
AU - van Dijk, Ewoud J.
AU - de Vries, Joost
AU - Schonewille, Wouter J.
AU - Vos, Jan Albert
AU - Hofmeijer, Jeannette
AU - van Oostayen, Jacques A.
AU - Vroomen, Patrick C.
AU - Eshghi, Omid
AU - de Kort, Paul L.
AU - van Rooij, Willem Jan
AU - Keizer, Koos
AU - Tielbeek, Xander
AU - de Bruijn, Bas F.
AU - van Dijk, Lukas C.
AU - van den Bergh, J. S. Peter
AU - van Hasselt, Boudewijn A.
AU - Aerden, Leo A.
AU - Dallinga, René J.
AU - Schreuder, Tobien
AU - Heijboer, Roel J.
AU - den Hertog, Heleen M.
AU - Gerrits, Dick G.
AU - Visser, Marieke C.
AU - Bot, Joost C.
AU - Dippel, Diederik W. J.
AU - van der Lugt, Aad
AU - Sprengers, Marieke E.
AU - Jenniskens, Sjoerd
AU - van den Berg, René
AU - Yoo, Albert J.
AU - Koudstaal, Peter J.
AU - van den Berg, Lucie
PY - 2015
Y1 - 2015
N2 - It has been suggested that CT Perfusion acquisition times <60 seconds are too short to capture the complete in and out-wash of contrast in the tissue, resulting in incomplete time attenuation curves. Yet, these short acquisitions times are not uncommon in clinical practice. The purpose of this study was to investigate the occurrence of time attenuation curve truncation in 48 seconds CT Perfusion acquisition and to quantify its effect on ischemic core and penumbra estimation in patients with acute ischemic stroke due to a proximal intracranial arterial occlusion of the anterior circulation. We analyzed CT Perfusion data with 48 seconds and extended acquisition times, assuring full time attenuation curves, of 36 patients. Time attenuation curves were classified as complete or truncated. Ischemic core and penumbra volumes resulting from both data sets were compared by median paired differences and interquartile ranges. Controlled experiments were performed using a digital CT Perfusion phantom to investigate the effect of time attenuation curve truncation on ischemic core and penumbra estimation. In 48 seconds acquisition data, truncation was observed in 24 (67%) cases for the time attenuation curves in the ischemic core, in 2 cases for the arterial input function and in 5 cases for the venous output function. Analysis of extended data resulted in smaller ischemic cores and larger penumbras with a median difference of 13.2 (IQR: 4.3-26.0) ml (P <0.001) and; 12.4 (IQR: 4.1-25.7) ml (P <0.001), respectively. The phantom data showed increasing ischemic core overestimation with increasing tissue time attenuation curve truncation. Truncation is common in patients with large vessel occlusion and results in repartitioning of the area of hypoperfusion into larger ischemic core and smaller penumbra estimations. Phantom experiments confirmed that truncation results in overestimation of the ischemic core
AB - It has been suggested that CT Perfusion acquisition times <60 seconds are too short to capture the complete in and out-wash of contrast in the tissue, resulting in incomplete time attenuation curves. Yet, these short acquisitions times are not uncommon in clinical practice. The purpose of this study was to investigate the occurrence of time attenuation curve truncation in 48 seconds CT Perfusion acquisition and to quantify its effect on ischemic core and penumbra estimation in patients with acute ischemic stroke due to a proximal intracranial arterial occlusion of the anterior circulation. We analyzed CT Perfusion data with 48 seconds and extended acquisition times, assuring full time attenuation curves, of 36 patients. Time attenuation curves were classified as complete or truncated. Ischemic core and penumbra volumes resulting from both data sets were compared by median paired differences and interquartile ranges. Controlled experiments were performed using a digital CT Perfusion phantom to investigate the effect of time attenuation curve truncation on ischemic core and penumbra estimation. In 48 seconds acquisition data, truncation was observed in 24 (67%) cases for the time attenuation curves in the ischemic core, in 2 cases for the arterial input function and in 5 cases for the venous output function. Analysis of extended data resulted in smaller ischemic cores and larger penumbras with a median difference of 13.2 (IQR: 4.3-26.0) ml (P <0.001) and; 12.4 (IQR: 4.1-25.7) ml (P <0.001), respectively. The phantom data showed increasing ischemic core overestimation with increasing tissue time attenuation curve truncation. Truncation is common in patients with large vessel occlusion and results in repartitioning of the area of hypoperfusion into larger ischemic core and smaller penumbra estimations. Phantom experiments confirmed that truncation results in overestimation of the ischemic core
U2 - https://doi.org/10.1371/journal.pone.0119409
DO - https://doi.org/10.1371/journal.pone.0119409
M3 - Article
C2 - 25789631
SN - 1932-6203
VL - 10
SP - e0119409
JO - PLOS ONE
JF - PLOS ONE
IS - 3
ER -