Imaging selection in ischemic stroke: feasibility of automated CT-perfusion analysis

被引:98
作者
Campbell, Bruce C. V. [1 ,2 ]
Yassi, Nawaf [1 ]
Ma, Henry [3 ]
Sharma, Gagan [2 ]
Salinas, Simon [2 ]
Churilov, Leonid [3 ]
Meretoja, Atte [1 ,3 ]
Parsons, Mark W. [4 ]
Desmond, Patricia M. [2 ]
Lansberg, Maarten G. [5 ]
Donnan, Geoffrey A. [3 ]
Davis, Stephen M. [1 ]
机构
[1] Royal Melbourne Hosp, Dept Med, Parkville, Vic 3050, Australia
[2] Royal Melbourne Hosp, Dept Radiol, Parkville, Vic 3050, Australia
[3] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Melbourne, Vic, Australia
[4] Univ Newcastle, John Hunter Hosp, Prior Res Ctr Brain & Mental Hlth Res, Newcastle, NSW 2300, Australia
[5] Stanford Univ, Med Ctr, Stanford Stroke Ctr, Dept Neurol & Neurol Sci, Stanford, CA 94305 USA
基金
英国医学研究理事会;
关键词
acute ischemic stroke; Perfusion CT; Perfusion MRI - PWI; penumbra imaging; thrombolysis; EMERGENCY NEUROLOGICAL DEFICITS; THROMBOLYSIS; TIME; MISMATCH; TRIAL; MULTICENTER; ALTEPLASE; EPITHET; EXTEND;
D O I
10.1111/ijs.12381
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Advanced imaging may refine patient selection for ischemic stroke treatment but delays to acquire and process the imaging have limited implementation. Aims We examined the feasibility of imaging selection in clinical practice using fully automated software in the EXTEND trial program. Methods CTP and perfusion-diffusion MRI data were processed using fully-automated software to generate a yes/no 'mismatch' classification that determined eligibility for trial therapies. The technical failure/mismatch classification error rate and time to image and treat with CT vs. MR-based selection were examined. Results In a consecutive series of 776 patients from five sites over six-months the technical failure rate of CTP acquisition/processing (uninterpretable maps) was 3.4% (26/776, 95% CI 2.2-4.9%). Mismatch classification was overruled by expert review in an additional 9.0% (70/776, 95% CI 7.1-11.3%) due to artifactual 'perfusion lesion'. In 154 consecutive patients at one site, median additional time to acquire CTP after non-contrast CT was 6.5 min. Subsequent RAPID processing time varied from 3-10 min across 20 trial centers (median 5 min 20 s). In the EXTEND trial, door-to-needle times in patients randomized on the basis of CTP (n = 47) were median 78 min shorter than MRI-selected (n = 16) patients (P < 0.001). Conclusions Automated CTP-based mismatch selection is rapid, robust in clinical practice, and associated with faster treatment decisions than MRI. This technological advance has the potential to improve the standardization and reproducibility of interpretation of advanced imaging and extend use to practice settings beyond highly specialized academic centers.
引用
收藏
页码:51 / 54
页数:4
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