Distal Medium Vessel Occlusions Can Be Accurately and Rapidly Detected Using Tmax Maps

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Distal medium vessel occlusions (DMVOs) are critical for endovascular thrombectomy but challenging to detect via computed tomography angiography (CTA).
• CT perfusion (CTP) imaging offers advanced insights into brain tissue perfusion dynamics.

Purpose of the Study:

• To evaluate the efficacy of time-to-maximum of tissue residue function (Tmax) maps from CTP as a rapid triage tool for identifying DMVOs.
• To compare the diagnostic accuracy and speed of Tmax maps versus CTA in detecting DMVOs.

Main Methods:

• Retrospective analysis of multimodal CT scans from stroke patients.
• Evaluation of Tmax maps for territorial delay by experienced readers.
• Receiver-operating characteristic (ROC) analysis to determine diagnostic accuracy.
• Comparison of Tmax map and CTA performance across readers with varying experience levels.

Main Results:

• Territorial Tmax delay demonstrated high sensitivity (100%) and specificity (87.8%) for DMVO detection, with an area under the ROC curve of 0.939.
• Readers using Tmax maps achieved significantly higher diagnostic accuracy and speed compared to CTA.
• Tmax map interpretation was accurate and rapid, even for less experienced readers.

Conclusions:

• Tmax delay on CTP maps is a highly sensitive and specific indicator for DMVOs.
• Tmax maps serve as an effective and efficient triage tool for identifying patients with DMVOs.
• The findings support the clinical utility of Tmax maps for rapid DMVO detection in stroke patients.