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Variations in contrast injection protocols across stroke centers significantly impact computed tomography perfusion (CTP) results, potentially affecting stroke diagnosis and treatment decisions.

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Area of Science:

  • Neuroimaging
  • Radiology
  • Medical Imaging Analysis

Background:

  • Multicenter stroke studies require standardized imaging protocols for reliable results.
  • Computed Tomography Perfusion (CTP) is crucial for assessing cerebral blood flow in stroke patients.
  • Arterial Input Function (AIF) characterization is a critical step in CTP analysis.

Purpose of the Study:

  • To quantify variations in the Arterial Input Function (AIF) across different centers in a multicenter stroke study.
  • To evaluate the impact of AIF variations on Computed Tomography Perfusion (CTP) results and derived infarct volumes.
  • To assess the clinical relevance of these variations on stroke diagnosis and treatment selection.

Main Methods:

  • Analysis of 1422 CTP datasets from the DUtch acute STroke (DUST) study across 14 centers.
  • Characterization of AIF using parameters like amplitude, Area Under the Curve (AUC), Bolus Arrival Time (BAT), and Time To Peak (TTP).
  • Simulation of CTP acquisitions using a digital phantom and analysis with commercial and in-house software to assess volumetric differences.

Main Results:

  • Significant inter-center variability was observed in AIF parameters (amplitude, AUC, BAT, TTP).
  • Mean infarct volumes derived from phantom data showed significant differences between centers, regardless of the analysis method used.
  • These volumetric discrepancies highlight the impact of AIF variations on CTP-derived metrics.

Conclusions:

  • Despite standardized acquisition protocols, contrast medium injection protocols vary among stroke centers.
  • These protocol variations directly influence CTP imaging results, including infarct core and penumbra volumes.
  • Inconsistent AIF measurements can lead to significant differences in stroke diagnosis and patient selection for reperfusion therapy.