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Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis
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. Met...
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Published in: | International journal of stroke 2015-01, Vol.10 (1), p.51-54 |
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container_title | International journal of stroke |
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creator | Campbell, Bruce C.V. Yassi, Nawaf Ma, Henry Sharma, Gagan Salinas, Simon Churilov, Leonid Meretoja, Atte Parsons, Mark W. Desmond, Patricia M. Lansberg, Maarten G. Donnan, Geoffrey A. Davis, Stephen M. |
description | 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 noncontrast 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. |
doi_str_mv | 10.1111/ijs.12381 |
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fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1642616488</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1111_ijs.12381</sage_id><sourcerecordid>1642616488</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3</originalsourceid><addsrcrecordid>eNqNkclKA0EQhhtR3A--gAwIoocxvc3S3kJwiQgKieehuqcmdpxFp2eQvL2tiSKKYB2q6vDVX1X8hBwwesZ8DOzcnTEuUrZGtlkik1Aqqda_ekG3yI5zc0pllIh4k2zxSDDFI7ZNpuMKZraeBRMs0XS2qQNbB2NnHrGyJph0bfOE58ElgrPalrZbBE0RDPuuqaDDPBhNw3tsi969Tw5rKBfOuj2yUUDpcH9Vd8nD5cV0dB3e3l2NR8Pb0MhUsDCiUucIXHIwhYQkVkKIPOcGFMcclQZQoBOlYmp0TDVoSCKINMuN5IggdsnJUve5bV56dF1WWWewLKHGpncZiyWPfUrTf6AiotTnxKNHP9B507f-tQ9KxqmkSeyp0yVl2sa5FovsubUVtIuM0ezdlcy7kn244tnDlWKvK8y_yE8bPDBYAq-2xMXfStn4ZvIpebyccDDDbwf-2v0GRZmiKw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1634684076</pqid></control><display><type>article</type><title>Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis</title><source>SAGE</source><creator>Campbell, Bruce C.V. ; Yassi, Nawaf ; Ma, Henry ; Sharma, Gagan ; Salinas, Simon ; Churilov, Leonid ; Meretoja, Atte ; Parsons, Mark W. ; Desmond, Patricia M. ; Lansberg, Maarten G. ; Donnan, Geoffrey A. ; Davis, Stephen M.</creator><creatorcontrib>Campbell, Bruce C.V. ; Yassi, Nawaf ; Ma, Henry ; Sharma, Gagan ; Salinas, Simon ; Churilov, Leonid ; Meretoja, Atte ; Parsons, Mark W. ; Desmond, Patricia M. ; Lansberg, Maarten G. ; Donnan, Geoffrey A. ; Davis, Stephen M.</creatorcontrib><description>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 noncontrast 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.</description><identifier>ISSN: 1747-4930</identifier><identifier>EISSN: 1747-4949</identifier><identifier>DOI: 10.1111/ijs.12381</identifier><identifier>PMID: 25319251</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>acute ischemic stroke ; Diffusion Magnetic Resonance Imaging - methods ; Feasibility Studies ; Humans ; Image Processing, Computer-Assisted - methods ; Multimodal Imaging - methods ; penumbra imaging ; Perfusion CT ; Perfusion MRI ; PWI ; Software ; Stroke - diagnosis ; Stroke - therapy ; thrombolysis ; Thrombolytic Therapy - methods ; Time-to-Treatment ; Tomography, X-Ray Computed - methods</subject><ispartof>International journal of stroke, 2015-01, Vol.10 (1), p.51-54</ispartof><rights>2014 World Stroke Organization</rights><rights>2014 World Stroke Organization.</rights><rights>International Journal of Stroke © 2015 World Stroke Organization</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3</citedby><cites>FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904,79110</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25319251$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Campbell, Bruce C.V.</creatorcontrib><creatorcontrib>Yassi, Nawaf</creatorcontrib><creatorcontrib>Ma, Henry</creatorcontrib><creatorcontrib>Sharma, Gagan</creatorcontrib><creatorcontrib>Salinas, Simon</creatorcontrib><creatorcontrib>Churilov, Leonid</creatorcontrib><creatorcontrib>Meretoja, Atte</creatorcontrib><creatorcontrib>Parsons, Mark W.</creatorcontrib><creatorcontrib>Desmond, Patricia M.</creatorcontrib><creatorcontrib>Lansberg, Maarten G.</creatorcontrib><creatorcontrib>Donnan, Geoffrey A.</creatorcontrib><creatorcontrib>Davis, Stephen M.</creatorcontrib><title>Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis</title><title>International journal of stroke</title><addtitle>Int J Stroke</addtitle><description>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 noncontrast 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.</description><subject>acute ischemic stroke</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Feasibility Studies</subject><subject>Humans</subject><subject>Image Processing, Computer-Assisted - methods</subject><subject>Multimodal Imaging - methods</subject><subject>penumbra imaging</subject><subject>Perfusion CT</subject><subject>Perfusion MRI</subject><subject>PWI</subject><subject>Software</subject><subject>Stroke - diagnosis</subject><subject>Stroke - therapy</subject><subject>thrombolysis</subject><subject>Thrombolytic Therapy - methods</subject><subject>Time-to-Treatment</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>1747-4930</issn><issn>1747-4949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqNkclKA0EQhhtR3A--gAwIoocxvc3S3kJwiQgKieehuqcmdpxFp2eQvL2tiSKKYB2q6vDVX1X8hBwwesZ8DOzcnTEuUrZGtlkik1Aqqda_ekG3yI5zc0pllIh4k2zxSDDFI7ZNpuMKZraeBRMs0XS2qQNbB2NnHrGyJph0bfOE58ElgrPalrZbBE0RDPuuqaDDPBhNw3tsi969Tw5rKBfOuj2yUUDpcH9Vd8nD5cV0dB3e3l2NR8Pb0MhUsDCiUucIXHIwhYQkVkKIPOcGFMcclQZQoBOlYmp0TDVoSCKINMuN5IggdsnJUve5bV56dF1WWWewLKHGpncZiyWPfUrTf6AiotTnxKNHP9B507f-tQ9KxqmkSeyp0yVl2sa5FovsubUVtIuM0ezdlcy7kn244tnDlWKvK8y_yE8bPDBYAq-2xMXfStn4ZvIpebyccDDDbwf-2v0GRZmiKw</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Campbell, Bruce C.V.</creator><creator>Yassi, Nawaf</creator><creator>Ma, Henry</creator><creator>Sharma, Gagan</creator><creator>Salinas, Simon</creator><creator>Churilov, Leonid</creator><creator>Meretoja, Atte</creator><creator>Parsons, Mark W.</creator><creator>Desmond, Patricia M.</creator><creator>Lansberg, Maarten G.</creator><creator>Donnan, Geoffrey A.</creator><creator>Davis, Stephen M.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201501</creationdate><title>Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis</title><author>Campbell, Bruce C.V. ; Yassi, Nawaf ; Ma, Henry ; Sharma, Gagan ; Salinas, Simon ; Churilov, Leonid ; Meretoja, Atte ; Parsons, Mark W. ; Desmond, Patricia M. ; Lansberg, Maarten G. ; Donnan, Geoffrey A. ; Davis, Stephen M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>acute ischemic stroke</topic><topic>Diffusion Magnetic Resonance Imaging - methods</topic><topic>Feasibility Studies</topic><topic>Humans</topic><topic>Image Processing, Computer-Assisted - methods</topic><topic>Multimodal Imaging - methods</topic><topic>penumbra imaging</topic><topic>Perfusion CT</topic><topic>Perfusion MRI</topic><topic>PWI</topic><topic>Software</topic><topic>Stroke - diagnosis</topic><topic>Stroke - therapy</topic><topic>thrombolysis</topic><topic>Thrombolytic Therapy - methods</topic><topic>Time-to-Treatment</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Campbell, Bruce C.V.</creatorcontrib><creatorcontrib>Yassi, Nawaf</creatorcontrib><creatorcontrib>Ma, Henry</creatorcontrib><creatorcontrib>Sharma, Gagan</creatorcontrib><creatorcontrib>Salinas, Simon</creatorcontrib><creatorcontrib>Churilov, Leonid</creatorcontrib><creatorcontrib>Meretoja, Atte</creatorcontrib><creatorcontrib>Parsons, Mark W.</creatorcontrib><creatorcontrib>Desmond, Patricia M.</creatorcontrib><creatorcontrib>Lansberg, Maarten G.</creatorcontrib><creatorcontrib>Donnan, Geoffrey A.</creatorcontrib><creatorcontrib>Davis, Stephen M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of stroke</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Campbell, Bruce C.V.</au><au>Yassi, Nawaf</au><au>Ma, Henry</au><au>Sharma, Gagan</au><au>Salinas, Simon</au><au>Churilov, Leonid</au><au>Meretoja, Atte</au><au>Parsons, Mark W.</au><au>Desmond, Patricia M.</au><au>Lansberg, Maarten G.</au><au>Donnan, Geoffrey A.</au><au>Davis, Stephen M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis</atitle><jtitle>International journal of stroke</jtitle><addtitle>Int J Stroke</addtitle><date>2015-01</date><risdate>2015</risdate><volume>10</volume><issue>1</issue><spage>51</spage><epage>54</epage><pages>51-54</pages><issn>1747-4930</issn><eissn>1747-4949</eissn><abstract>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 noncontrast 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.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>25319251</pmid><doi>10.1111/ijs.12381</doi><tpages>4</tpages></addata></record> |
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subjects | acute ischemic stroke Diffusion Magnetic Resonance Imaging - methods Feasibility Studies Humans Image Processing, Computer-Assisted - methods Multimodal Imaging - methods penumbra imaging Perfusion CT Perfusion MRI PWI Software Stroke - diagnosis Stroke - therapy thrombolysis Thrombolytic Therapy - methods Time-to-Treatment Tomography, X-Ray Computed - methods |
title | Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis |
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