@article{9459a9c92938492a97f20614e3aabaac,
title = "Variation in arterial input function in a large multicenter computed tomography perfusion study",
abstract = "Objectives: To report the variation in computed tomography perfusion (CTP) arterial input function (AIF) in a multicenter stroke study and to assess the impact this has on CTP results. Methods: CTP datasets from 14 different centers were included from the DUtch acute STroke (DUST) study. The AIF was taken as a direct measure to characterize contrast bolus injection. Statistical analysis was applied to evaluate differences in amplitude, area under the curve (AUC), bolus arrival time (BAT), and time to peak (TTP). To assess the clinical relevance of differences in AIF, CTP acquisitions were simulated with a realistic anthropomorphic digital phantom. Perfusion parameters were extracted by CTP analysis using commercial software (IntelliSpace Portal (ISP), version 10.1) as well as an in-house method based on block-circulant singular value decomposition (bSVD). Results: A total of 1422 CTP datasets were included, ranging from 6 to 322 included patients per center. The measured values of the parameters used to characterize the AIF differed significantly with approximate interquartile ranges of 200–750 HU for the amplitude, 2500–10,000 HU·s for the AUC, 0–17 s for the BAT, and 10–26 s for the TTP. Mean infarct volumes of the phantom were significantly different between centers for both methods of perfusion analysis. Conclusions: Although guidelines for the acquisition protocol are often provided for centers participating in a multicenter study, contrast medium injection protocols still vary. The resulting volumetric differences in infarct core and penumbra may impact clinical decision making in stroke diagnosis. Key Points: • The contrast medium injection protocol may be different between stroke centers participating in a harmonized multicenter study. • The contrast medium injection protocol influences the results of X-ray computed tomography perfusion imaging. • The contrast medium injection protocol can impact stroke diagnosis and patient selection for treatment.",
keywords = "Contrast media, Perfusion imaging, Stroke, Tomography, X-ray computed",
author = "{On behalf of the DUtch acute STroke (DUST) study investigators} and Daan Peerlings and Edwin Bennink and Dankbaar, {Jan W.} and Velthuis, {Birgitta K.} and {de Jong}, {Hugo W.A.M.} and Majoie, {C. B.} and Roos, {Y. B.} and Duijm, {L. E.} and K. Keizer and {van der Lugt}, A. and Dippel, {D. W.} and {Droogh-de Greeve}, {K. E.} and Bienfait, {H. P.} and {van Walderveen}, {M. A.} and Wermer, {M. J.} and {Lycklama {\`a} Nijeholt}, {G. J.} and J. Boiten and D. Duyndam and Kwa, {V. I.} and Meijer, {F. J.} and {van Dijk}, {E. J.} and Kesselring, {F. O.} and J. Hofmeijer and Vos, {J. A.} and Schonewille, {W. J.} and {van Rooij}, {W. J.} and {de Kort}, {P. L.} and Pleiter, {C. C.} and Bakker, {S. L.} and J. Bot and Visser, {M. C.} and Velthuis, {B. K.} and {van der Schaaf}, {I. C.} and Dankbaar, {J. W.} and Mali, {W. P.} and {van Seeters}, T. and Horsch, {A. D.} and Niesten, {J. M.} and Biessels, {G. J.} and Kappelle, {L. J.} and Luitse, {M. J.} and {van der Graaf}, Y.",
note = "Funding Information: This research is part of the Leading the Change program made possible by the trial agency Zorgevaluatie Nederland. The Dutch acute stroke trial (DUST) investigators are: Academic Medical Center, Amsterdam, The Netherlands (Majoie CB, Roos YB); Catharina Hospital, Eindhoven, The Netherlands (Duijm LE, Keizer K); Erasmus Medical Center, Rotterdam, The Netherlands (van der Lugt A, Dippel DW); Gelre Hospitals, Apeldoorn, The Netherlands (Droogh - de Greeve KE, Bienfait HP); Leiden University Medical Center, Leiden, The Netherlands (van Walderveen MA, Wermer MJ); Medical Center Haaglanden, The Hague, The Netherlands (Lycklama {\`a} Nijeholt GJ, Boiten J); Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (Duyndam D, Kwa VI); Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (Meijer FJ, van Dijk EJ); Rijnstate Hospital, Arnhem, The Netherlands (Kesselring FO, Hofmeijer J); St. Antonius Hospital, Nieuwegein, The Netherlands (Vos JA, Schonewille WJ); St. Elisabeth Hospital, Tilburg, The Netherlands (van Rooij WJ, de Kort PL); St. Franciscus Hospital, Rotterdam, The Netherlands (Pleiter CC, Bakker SL); VU Medical Center, Amsterdam, The Netherlands (Bot J, Visser MC); University Medical Center Utrecht, Utrecht, The Netherlands (Velthuis BK, van der Schaaf IC, Dankbaar JW, Mali WP, van Seeters T, Horsch AD, Niesten JM, Biessels GJ, Kappelle LJ, Luitse MJ, van der Graaf Y). Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2021",
month = nov,
doi = "https://doi.org/10.1007/s00330-021-08067-6",
language = "English",
volume = "31",
pages = "8317--8325",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "11",
}