Cerebral attenuation on single-phase CT angiography source images: Automated ischemia detection and morphologic outcome prediction after thrombectomy in patients with ischemic stroke

Objectives Stroke triage using CT perfusion (CTP) or MRI gained importance after successful application in recent trials on late-window thrombectomy but is often unavailable and time-consuming. We tested the clinical value of software-based analysis of cerebral attenuation on Single-phase CT angiogr...

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Bibliographic Details
Published in:PloS one 2020-08, Vol.15 (8), p.e0236956-e0236956
Main Authors: Reidler, Paul, Puhr-Westerheide, Daniel, Rotkopf, Lukas, Fabritius, Matthias P, Feil, Katharina, Kellert, Lars, Tiedt, Steffen, Rémi, Jan, Liebig, Thomas, Kunz, Wolfgang G
Format: Article
Language:English
Subjects:
Angiography
Attenuation
Automation
Biology and Life Sciences
Blood
Blood flow
Blood vessels
Care and treatment
CAT scans
Cerebral angiography
Cerebral blood flow
Cerebral infarction
Classification
Clinical trials
Computed tomography
Computer programs
Contrast agents
Ground truth
Image acquisition
Image segmentation
Infarction
Ischemia
Magnetic resonance imaging
Mathematical analysis
Medical diagnostic software
Medical imaging
Medicine and Health Sciences
Methods
Neuroimaging
Neurology
Occlusion
Patient outcomes
Perfusion
Regions
Research and Analysis Methods
Segmentation
Software
Stroke
Vascular surgery
Visual aspects
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Summary:Objectives Stroke triage using CT perfusion (CTP) or MRI gained importance after successful application in recent trials on late-window thrombectomy but is often unavailable and time-consuming. We tested the clinical value of software-based analysis of cerebral attenuation on Single-phase CT angiography source images (CTASI) as CTP surrogate in stroke patients. Methods Software-based automated segmentation and Hounsfield unit (HU) measurements for all regions of the Alberta Stroke Program Early CT Score (ASPECTS) on CTASI were performed in patients with large vessel occlusion stroke who underwent thrombectomy. To normalize values, we calculated relative HU (rHU) as ratio of affected to unaffected hemisphere. Ischemic regions, regional ischemic core and final infarction were determined on simultaneously acquired CTP and follow-up imaging as ground truth. Receiver operating characteristics analysis was performed to calculate the area-under-the-curve (AUC). Resulting cut-off values were used for comparison with visual analysis and to calculate an 11-point automated CTASI ASPECTS. Results Seventy-nine patients were included. rHU values enabled significant classification of ischemic involvement on CTP in all ten regions of the ASPECTS (each p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0236956