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CT perfusion stroke lesion threshold calibration between deconvolution algorithms.

Kevin J Chung1,2,3, Danny De Sarno2,3, Ting-Yim Lee4,5,6,7

  • 1Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.

Scientific Reports
|December 5, 2023
PubMed
Summary
This summary is machine-generated.

Calibrating computed tomography perfusion (CTP) thresholds improves agreement between different software used for acute ischemic stroke analysis. This method harmonizes stroke lesion volumes and core-penumbra mismatch profiles for better clinical decisions.

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Area of Science:

  • Neurology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Computed tomography perfusion (CTP) is crucial for acute ischemic stroke management.
  • Discrepancies in CTP post-processing software affect stroke lesion volume and core-penumbra mismatch assessment.
  • Improving inter-software agreement is vital for reliable clinical decision-making.

Purpose of the Study:

  • To develop and validate a systematic method for calibrating CTP stroke lesion thresholds across different deconvolution algorithms.
  • To enhance the agreement of ischemic core and penumbra mismatch profiles between various CTP post-processing software.
  • To improve the consistency of CTP-derived metrics for acute ischemic stroke patient management.

Main Methods:

  • A digital perfusion phantom was used to calibrate CTP stroke lesion thresholds between model-independent and model-based deconvolution algorithms.
  • Linear regression compared deconvolution-estimated cerebral blood flow (CBF) and Tmax to phantom ground truth.
  • Calibrated thresholds were validated in 63 large vessel stroke patients using concordance and Cohen's kappa (κ).

Main Results:

  • Model-based deconvolution algorithms yielded calibrated thresholds of CBF < 15% and Tmax > 6 s, aligning with the clinical standard.
  • Validation in patients showed 95% concordance between model-based and model-independent methods.
  • Excellent agreement was observed, with Cohen's kappa values of κ = 0.87 and κ = 0.86.

Conclusions:

  • A systematic calibration method for CTP stroke lesion thresholds can significantly improve inter-software agreement.
  • Harmonized mismatch profiles derived from different CTP software enhance diagnostic reliability.
  • This approach holds potential for standardizing CTP analysis in acute ischemic stroke management.