Loading…

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...

Full description

Saved in:
Bibliographic Details
Published in:International journal of stroke 2015-01, Vol.10 (1), p.51-54
Main Authors: 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.
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3
cites cdi_FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3
container_end_page 54
container_issue 1
container_start_page 51
container_title International journal of stroke
container_volume 10
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
format article
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 &lt; 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 &lt; 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 &amp; 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 &lt; 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>
fulltext fulltext
identifier ISSN: 1747-4930
ispartof International journal of stroke, 2015-01, Vol.10 (1), p.51-54
issn 1747-4930
1747-4949
language eng
recordid cdi_proquest_miscellaneous_1642616488
source SAGE
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
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T22%3A23%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Imaging%20Selection%20in%20Ischemic%20Stroke:%20Feasibility%20of%20Automated%20CT-Perfusion%20Analysis&rft.jtitle=International%20journal%20of%20stroke&rft.au=Campbell,%20Bruce%20C.V.&rft.date=2015-01&rft.volume=10&rft.issue=1&rft.spage=51&rft.epage=54&rft.pages=51-54&rft.issn=1747-4930&rft.eissn=1747-4949&rft_id=info:doi/10.1111/ijs.12381&rft_dat=%3Cproquest_cross%3E1642616488%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c4831-504bdea242acf4a769333dd2ca92ede9baa9ab79960cb60baba75a5b1dc42eea3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1634684076&rft_id=info:pmid/25319251&rft_sage_id=10.1111_ijs.12381&rfr_iscdi=true