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Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
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Automated Perfusion Calculations vs. Visual Scoring of Collaterals and CBV-ASPECTS : Has the Machine Surpassed the
Marios-Nikos Psychogios1, Peter B Sporns2,3, Johanna Ospel2,4
1Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Spitalstr. 21, 4031, Basel, Switzerland. marios.psychogios@usb.ch.
Clinical Neuroradiology
|November 20, 2020
Summary
Automated perfusion software and collateral scoring predict functional outcomes in stroke patients undergoing mechanical thrombectomy. However, core and penumbra volume estimates vary significantly between software packages, necessitating cautious use.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Automated perfusion software is increasingly vital for assessing stroke patients eligible for mechanical thrombectomy (MT).
- Accurate estimation of infarct core and penumbra volumes is crucial for guiding MT treatment decisions.
- Comparing different software packages and traditional imaging markers is essential for understanding their predictive value.
Purpose of the Study:
- To compare four automated perfusion software packages for stroke imaging.
- To assess the association of software-derived core and penumbra volumes with 3-month functional outcomes after MT.
- To compare software agreement in estimating core and penumbra volumes against visual Cerebral Blood Volume - Alberta Stroke Program Early CT Score (CBV-ASPECTS) and collateral scoring.
Main Methods:
- Retrospective, multicenter cohort study analyzing data from 8 centers (2015-2019).
- Included patients with successful MT of the middle cerebral artery who were functionally independent pre-stroke.
- Primary outcomes: relationship of core/penumbra volumes (from each software) with 3-month functional outcome/disability (modified Rankin Scale >2), and quantitative differences between software measurements.
Main Results:
- Multivariable analyses revealed significant associations between RAPID software core volume, CBV-ASPECTS, and collateral scoring with 3-month functional outcome and disability.
- RAPID core, CBV-ASPECTS, and OLEA core showed significant associations with 3-month functional disability.
- Mean differences in core volume estimates between software packages ranged from -3.2 ml (OLEA vs. RAPID) to 30.0 ml (syngo.via vs. RAPID).
Conclusions:
- Collateral scoring, CBV-ASPECTS, and the RAPID software are independently associated with 90-day functional outcomes in MT patients.
- Significant variations exist in core and penumbra volume estimations among automated perfusion software packages.
- Automated perfusion software should be used with caution due to variability in volume estimations.
