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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Recent Administration of Iodinated Contrast Renders Core Infarct Estimation Inaccurate Using RAPID Software
A Z Copelan1, E R Smith1,2, G T Drocton1
1From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.).
AJNR. American Journal of Neuroradiology
|November 20, 2020
Summary
Automated CTP software like RAPID may underestimate core infarct in stroke patients who recently received IV contrast. This contrast administration is linked to lower infarct estimates, requiring caution in treatment decisions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Automated CTP software is vital for quantifying core infarct in emergent large-vessel occlusion.
- Extended window treatment protocols require accurate infarct volume assessment.
Purpose of the Study:
- To evaluate if RAPID software underestimates core infarct in patients receiving IV iodinated contrast within 8 hours before CTP.
- To compare infarct estimates between contrast-exposed and contrast-naïve patients.
Main Methods:
- Prospective analysis of 271 acute ischemic stroke patients undergoing CTA/CTP.
- RAPID software used <30% relative cerebral blood flow for core infarct estimation.
- Patients were grouped based on recent IV iodinated contrast administration (<8 hours prior).
Main Results:
- Recent IV contrast administration was independently associated with a decrease in RAPID core infarct estimates (P=.04).
- The contrast group showed a 0.34 proportional increase in underestimation compared to contrast-naïve patients.
Conclusions:
- Recent IV contrast administration increases the likelihood of core infarct underestimation by RAPID software.
- Caution is advised when relying solely on RAPID for treatment decisions in extended window stroke patients with recent contrast exposure.
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