Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion

Yu Sakai, Bradley N. Delman, Johanna T. Fifi, Stanley Tuhrim, Danielle Wheelwright, Amish H. Doshi, J. Mocco, Kambiz Nael

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Purpose- Estimation of infarction based on computed tomographic perfusion (CTP) has been challenging, mainly because of noise associated with CTP data. The Bayesian method is a robust probabilistic method that minimizes effects of oscillation, tracer delay, and noise during residue function estimation compared with other deconvolution methods. This study compares CTP-estimated ischemic core volume calculated by the Bayesian method and by the commonly used block-circulant singular value deconvolution technique. Methods- Patients were included if they had (1) anterior circulation ischemic stroke, (2) baseline CTP, (3) successful recanalization defined by thrombolysis in cerebral infarction ≥IIb, and (4) minimum infarction volume of >5 mL on follow-up magnetic resonance imaging (MRI). CTP data were processed with circulant singular value deconvolution and Bayesian methods. Two established CTP methods for estimation of ischemic core volume were applied: cerebral blood flow (CBF) method (relative CBF, <30% within the region of delay >2 seconds) and cerebral blood volume method (<2 mL per 100 g within the region of relative mean transit time >145%). Final infarct volume was determined on MRI (fluid-attenuated inversion recovery images). CTP and MRI-derived ischemic core volumes were compared by univariate and Bland-Altman analysis. Results- Among 35 patients included, the mean/median (mL) difference for CTP-estimated ischemic core volume against MRI was -4/-7 for Bayesian CBF ( P=0.770), 20/12 for Bayesian cerebral blood volume ( P=0.041), 21/10 for circulant singular value deconvolution CBF ( P=0.006), and 35/18 for circulant singular value deconvolution cerebral blood volume ( P<0.001). Among all methods, Bayesian CBF provided the narrowest limits of agreement (-28 to 19 mL) in comparison with MRI. Conclusions- Despite existing variabilities between CTP postprocessing methods, Bayesian postprocessing increases accuracy and limits variability in CTP estimation of ischemic core.

Original languageEnglish (US)
Pages (from-to)2345-2352
Number of pages8
JournalStroke
Volume49
Issue number10
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Perfusion
Bayes Theorem
Magnetic Resonance Imaging
Infarction
Noise
Magnetic Resonance Angiography
Cerebral Infarction
Stroke
Cerebral Blood Volume

Keywords

  • computed tomography
  • follow-up studies
  • humans
  • infarction
  • magnetic resonance imaging
  • perfusion imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Sakai, Y., Delman, B. N., Fifi, J. T., Tuhrim, S., Wheelwright, D., Doshi, A. H., ... Nael, K. (2018). Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion. Stroke, 49(10), 2345-2352. https://doi.org/10.1161/STROKEAHA.118.021952

Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion. / Sakai, Yu; Delman, Bradley N.; Fifi, Johanna T.; Tuhrim, Stanley; Wheelwright, Danielle; Doshi, Amish H.; Mocco, J.; Nael, Kambiz.

In: Stroke, Vol. 49, No. 10, 01.10.2018, p. 2345-2352.

Research output: Contribution to journalArticle

Sakai, Y, Delman, BN, Fifi, JT, Tuhrim, S, Wheelwright, D, Doshi, AH, Mocco, J & Nael, K 2018, 'Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion', Stroke, vol. 49, no. 10, pp. 2345-2352. https://doi.org/10.1161/STROKEAHA.118.021952
Sakai Y, Delman BN, Fifi JT, Tuhrim S, Wheelwright D, Doshi AH et al. Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion. Stroke. 2018 Oct 1;49(10):2345-2352. https://doi.org/10.1161/STROKEAHA.118.021952
Sakai, Yu ; Delman, Bradley N. ; Fifi, Johanna T. ; Tuhrim, Stanley ; Wheelwright, Danielle ; Doshi, Amish H. ; Mocco, J. ; Nael, Kambiz. / Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion. In: Stroke. 2018 ; Vol. 49, No. 10. pp. 2345-2352.
@article{636988dfe1fc43fea03675db25d4bdd3,
title = "Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion",
abstract = "Background and Purpose- Estimation of infarction based on computed tomographic perfusion (CTP) has been challenging, mainly because of noise associated with CTP data. The Bayesian method is a robust probabilistic method that minimizes effects of oscillation, tracer delay, and noise during residue function estimation compared with other deconvolution methods. This study compares CTP-estimated ischemic core volume calculated by the Bayesian method and by the commonly used block-circulant singular value deconvolution technique. Methods- Patients were included if they had (1) anterior circulation ischemic stroke, (2) baseline CTP, (3) successful recanalization defined by thrombolysis in cerebral infarction ≥IIb, and (4) minimum infarction volume of >5 mL on follow-up magnetic resonance imaging (MRI). CTP data were processed with circulant singular value deconvolution and Bayesian methods. Two established CTP methods for estimation of ischemic core volume were applied: cerebral blood flow (CBF) method (relative CBF, <30{\%} within the region of delay >2 seconds) and cerebral blood volume method (<2 mL per 100 g within the region of relative mean transit time >145{\%}). Final infarct volume was determined on MRI (fluid-attenuated inversion recovery images). CTP and MRI-derived ischemic core volumes were compared by univariate and Bland-Altman analysis. Results- Among 35 patients included, the mean/median (mL) difference for CTP-estimated ischemic core volume against MRI was -4/-7 for Bayesian CBF ( P=0.770), 20/12 for Bayesian cerebral blood volume ( P=0.041), 21/10 for circulant singular value deconvolution CBF ( P=0.006), and 35/18 for circulant singular value deconvolution cerebral blood volume ( P<0.001). Among all methods, Bayesian CBF provided the narrowest limits of agreement (-28 to 19 mL) in comparison with MRI. Conclusions- Despite existing variabilities between CTP postprocessing methods, Bayesian postprocessing increases accuracy and limits variability in CTP estimation of ischemic core.",
keywords = "computed tomography, follow-up studies, humans, infarction, magnetic resonance imaging, perfusion imaging",
author = "Yu Sakai and Delman, {Bradley N.} and Fifi, {Johanna T.} and Stanley Tuhrim and Danielle Wheelwright and Doshi, {Amish H.} and J. Mocco and Kambiz Nael",
year = "2018",
month = "10",
day = "1",
doi = "10.1161/STROKEAHA.118.021952",
language = "English (US)",
volume = "49",
pages = "2345--2352",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion

AU - Sakai, Yu

AU - Delman, Bradley N.

AU - Fifi, Johanna T.

AU - Tuhrim, Stanley

AU - Wheelwright, Danielle

AU - Doshi, Amish H.

AU - Mocco, J.

AU - Nael, Kambiz

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background and Purpose- Estimation of infarction based on computed tomographic perfusion (CTP) has been challenging, mainly because of noise associated with CTP data. The Bayesian method is a robust probabilistic method that minimizes effects of oscillation, tracer delay, and noise during residue function estimation compared with other deconvolution methods. This study compares CTP-estimated ischemic core volume calculated by the Bayesian method and by the commonly used block-circulant singular value deconvolution technique. Methods- Patients were included if they had (1) anterior circulation ischemic stroke, (2) baseline CTP, (3) successful recanalization defined by thrombolysis in cerebral infarction ≥IIb, and (4) minimum infarction volume of >5 mL on follow-up magnetic resonance imaging (MRI). CTP data were processed with circulant singular value deconvolution and Bayesian methods. Two established CTP methods for estimation of ischemic core volume were applied: cerebral blood flow (CBF) method (relative CBF, <30% within the region of delay >2 seconds) and cerebral blood volume method (<2 mL per 100 g within the region of relative mean transit time >145%). Final infarct volume was determined on MRI (fluid-attenuated inversion recovery images). CTP and MRI-derived ischemic core volumes were compared by univariate and Bland-Altman analysis. Results- Among 35 patients included, the mean/median (mL) difference for CTP-estimated ischemic core volume against MRI was -4/-7 for Bayesian CBF ( P=0.770), 20/12 for Bayesian cerebral blood volume ( P=0.041), 21/10 for circulant singular value deconvolution CBF ( P=0.006), and 35/18 for circulant singular value deconvolution cerebral blood volume ( P<0.001). Among all methods, Bayesian CBF provided the narrowest limits of agreement (-28 to 19 mL) in comparison with MRI. Conclusions- Despite existing variabilities between CTP postprocessing methods, Bayesian postprocessing increases accuracy and limits variability in CTP estimation of ischemic core.

AB - Background and Purpose- Estimation of infarction based on computed tomographic perfusion (CTP) has been challenging, mainly because of noise associated with CTP data. The Bayesian method is a robust probabilistic method that minimizes effects of oscillation, tracer delay, and noise during residue function estimation compared with other deconvolution methods. This study compares CTP-estimated ischemic core volume calculated by the Bayesian method and by the commonly used block-circulant singular value deconvolution technique. Methods- Patients were included if they had (1) anterior circulation ischemic stroke, (2) baseline CTP, (3) successful recanalization defined by thrombolysis in cerebral infarction ≥IIb, and (4) minimum infarction volume of >5 mL on follow-up magnetic resonance imaging (MRI). CTP data were processed with circulant singular value deconvolution and Bayesian methods. Two established CTP methods for estimation of ischemic core volume were applied: cerebral blood flow (CBF) method (relative CBF, <30% within the region of delay >2 seconds) and cerebral blood volume method (<2 mL per 100 g within the region of relative mean transit time >145%). Final infarct volume was determined on MRI (fluid-attenuated inversion recovery images). CTP and MRI-derived ischemic core volumes were compared by univariate and Bland-Altman analysis. Results- Among 35 patients included, the mean/median (mL) difference for CTP-estimated ischemic core volume against MRI was -4/-7 for Bayesian CBF ( P=0.770), 20/12 for Bayesian cerebral blood volume ( P=0.041), 21/10 for circulant singular value deconvolution CBF ( P=0.006), and 35/18 for circulant singular value deconvolution cerebral blood volume ( P<0.001). Among all methods, Bayesian CBF provided the narrowest limits of agreement (-28 to 19 mL) in comparison with MRI. Conclusions- Despite existing variabilities between CTP postprocessing methods, Bayesian postprocessing increases accuracy and limits variability in CTP estimation of ischemic core.

KW - computed tomography

KW - follow-up studies

KW - humans

KW - infarction

KW - magnetic resonance imaging

KW - perfusion imaging

UR - http://www.scopus.com/inward/record.url?scp=85055610928&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055610928&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.118.021952

DO - 10.1161/STROKEAHA.118.021952

M3 - Article

C2 - 30355089

AN - SCOPUS:85055610928

VL - 49

SP - 2345

EP - 2352

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 10

ER -