Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction
Christopher D d'Esterre1, Anurag Trivedi1, Pooneh Pordeli1
1From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., M.B., S.P., M.N., P.B., S.C., M.D.H., A.M.D., T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., M.D.H., N.D.F., M.G., T.-Y.L.), Department of Community Health Sciences (P.P., M.D.H., T.S.), and Hotchkiss Brain Institute (P.B., S.C., M.D.H., A.M.D., M.G.), University of Calgary, AB; Seaman Family Center, Calgary, Alberta (C.D.d'E., M.N., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Vancouver Island Health, Victoria, BC (A.T.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Diagnostic Imaging, University Hospital, Florence, Italy (E.F.); Department of Neurology, Neuroradiology, Dalhousie University, Halifax, Nova Scotia (J.J.S.S.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurology, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Clinical Neurosciences, University of Western Ontario, London (J.M., A.V.K.); and Lawson Health Research Institute and Robarts Research Institute, London, ON (A.V.K., T.-Y.L.).
Background And Purpose:
Within different brain regions, we determine the comparative value of multiphase computed tomographic angiography (mCTA) and computed tomographic perfusion (CTP) in predicting follow-up infarction.
Methods:
Patients with M1-middle cerebral artery occlusions were prospectively included in this multicenter study. Regional analysis was performed for each patient within Alberta Stroke Program Early CT Score regions M2 to M6. Regional pial vessel filling was assessed on mCTA in 3 ways: (1) Washout of contrast within pial vessels; (2) Extent of maximal pial vessel enhancement compared with contralateral hemisphere; (3) Delay in maximal pial vessel enhancement compared with contralateral hemisphere. Cerebral blood flow, cerebral blood volume, and Tmax data were extracted within these Alberta Stroke Program Early CT Score regions. Twenty-four- to 36-hour magnetic resonance imaging/CT was assessed for infarct in each Alberta Stroke Program Early CT Score region (defined as >20% infarction within that region). Mixed effects logistic regression models were used to compare mCTA and CTP parameters when predicting brain infarction. Area under the receiver operating characteristics was used to assess discriminative value of statistical models.
Results:
Seventy-seven patients were included. mCTA parameter washout and CTP parameter Tmax were significantly associated with follow-up infarction in all models (P<0.05). The area under the receiver operating characteristic for mCTA models ranged from 92% to 94% and was not different compared with all CTP models (P>0.05). Mean Tmax and cerebral blood volume values were significantly different between each washout score (P<0.01) and each delay score category (P<0.01). Mean Tmax, cerebral blood flow, and cerebral blood volume values were significantly different between each extent score category (P<0.05).
Conclusions:
Similar to CTP, multiphase CTA can be used to predict tissue fate regionally in acute ischemic stroke patients.
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