Utility of automated CT perfusion software in acute ischemic stroke with large and medium vessel occlusion.

IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2024-10-07 DOI:10.1002/acn3.52207
Rezan Ashayeri Ahmadabad, Kim H Tran, Yiran Zhang, Mahesh P Kate, Sachin Mishra, Brian H Buck, Khurshid A Khan, Jeremy Rempel, Gregory W Albers, Ashfaq Shuaib
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Abstract

Background: Early diagnosis of large vessel occlusion (LVO) in acute stroke often requires CT angiography (CTA). Automated CT perfusion (CTP) software, which identifies blood flow abnormalities, enhances LVO diagnosis and patient selection for endovascular thrombectomy (EVT). This study evaluates the sensitivity of automated CTP images in detecting perfusion abnormalities in patients with acute ischemic stroke (AIS) and LVO or medium vessel occlusion (MeVO), compared to CTA.

Methods: We screened acute ischemic stroke patients presenting within 24 h who underwent CT, CTA, and CTP as per institutional protocol. RAPID AI software processed CTP images, while neuroradiologists reviewed CTA for intracranial arterial occlusions. Sensitivity, specificity, and accuracy of automated CTP maps in detecting occlusions were assessed.

Results: Of 790 screened patients, 31 were excluded due to lack of RAPID CTP data or poor-quality scans, leaving 759 for analysis. The median age was 71 years (IQR: 61-81), with 47% female. Among them, 678 had AIS, and 81 had AIS ruled out. CTA identified arterial occlusion in 562 patients (74%), with corresponding CTP abnormalities in 537 patients (Tmax > 6 sec). In the 197 without occlusion, CTP was negative in 161. Automated CTP maps had a sensitivity of 95.55% (CI 95: 93.50-97.10%), specificity of 81.73% (CI 95: 75.61-86.86%), negative predictive value of 98.22% (CI 95: 97.39-98.79%), positive predictive value of 63.54% (CI 95: 56.46-70.09%), and overall accuracy of 85.18% (CI 95: 82.45-87.64%).

Conclusions: Automated CTP maps demonstrated high sensitivity and negative predictive value for LVOs and MeVOs, suggesting their usefulness as a rapid diagnostic tool, especially in settings without expert neuroradiologists.

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自动 CT 灌注软件在大血管和中血管闭塞的急性缺血性中风中的应用。
背景:急性中风大血管闭塞(LVO)的早期诊断通常需要 CT 血管造影术(CTA)。自动 CT 灌注(CTP)软件可识别血流异常,从而加强 LVO 诊断和血管内血栓切除术(EVT)的患者选择。与 CTA 相比,本研究评估了自动 CTP 图像在检测急性缺血性卒中(AIS)和 LVO 或中血管闭塞(MeVO)患者灌注异常方面的灵敏度:我们筛选了 24 小时内就诊的急性缺血性脑卒中患者,这些患者按照机构规定接受了 CT、CTA 和 CTP 检查。RAPID AI 软件处理 CTP 图像,而神经放射科医生则对 CTA 进行颅内动脉闭塞检查。对自动 CTP 图检测闭塞的敏感性、特异性和准确性进行了评估:在 790 名接受筛查的患者中,31 人因缺乏 RAPID CTP 数据或扫描质量不佳而被排除,剩下 759 人接受分析。中位年龄为 71 岁(IQR:61-81),女性占 47%。其中 678 人患有 AIS,81 人排除了 AIS。CTA 发现 562 名患者(74%)存在动脉闭塞,537 名患者存在相应的 CTP 异常(Tmax > 6 秒)。在 197 名没有闭塞的患者中,161 人的 CTP 为阴性。自动 CTP 地图的敏感性为 95.55%(CI 95:93.50-97.10%),特异性为 81.73%(CI 95:75.61-86.86%),阴性预测值为 98.22%(CI 95:97.39-98.79%),阳性预测值为 63.54%(CI 95:56.46-70.09%),总体准确性为 85.18%(CI 95:82.45-87.64%):自动CTP图显示了对LVOs和MeVOs的高灵敏度和阴性预测值,表明其作为快速诊断工具的实用性,尤其是在没有神经放射专家的情况下。
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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