Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes
Abstract The complexity of CT perfusion (CTP) acquisition protocols may limit the availability of target mismatch assessment at resource-limited hospitals. We compared CTP mismatch with a mismatch surrogate generated from a simplified dynamic imaging sequence comprising widely available non-contrast...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-48832-9 |
| _version_ | 1797388432696147968 |
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| author | Kevin J. Chung Sachin K. Pandey Alexander V. Khaw Ting-Yim Lee |
| author_facet | Kevin J. Chung Sachin K. Pandey Alexander V. Khaw Ting-Yim Lee |
| author_sort | Kevin J. Chung |
| collection | DOAJ |
| description | Abstract The complexity of CT perfusion (CTP) acquisition protocols may limit the availability of target mismatch assessment at resource-limited hospitals. We compared CTP mismatch with a mismatch surrogate generated from a simplified dynamic imaging sequence comprising widely available non-contrast CT (NCCT) and multiphase CT angiography (mCTA). Consecutive patients with anterior circulation acute ischemic stroke who received NCCT, mCTA, and CTP were retrospectively included in this study. An mCTA-perfusion (mCTA-P) dynamic series was formed by co-registering NCCT and mCTA. We simulated an ideal mCTA-P study by down-sampling CTP (dCTP) dynamic images according to mCTA timing. Ischemic core and penumbra volumes were estimated by cerebral blood flow and Tmax thresholding, respectively, on perfusion maps calculated independently for CTP, dCTP, and mCTA-P by deconvolution. Concordance in target mismatch (core < 70 ml, penumbra ≥ 15 ml, mismatch ratio ≥ 1.8) determination by dCTP and mCTA-P versus CTP was assessed. Of sixty-one included patients, forty-six had a CTP target mismatch. Concordance with CTP profiles was 90% and 82% for dCTP and mCTA-P, respectively. Lower mCTA-P concordance was likely from differences in collimation width between NCCT and mCTA, which worsened perfusion map quality due to a CT number shift at mCTA. Moderate diagnostic agreement between CTP and mCTA-P was found and may improve with optimal mCTA scan parameter selection as simulated by dCTP. mCTA-P may be a pragmatic alternative where CTP is unavailable or the risks of additional radiation dose, contrast injections, and treatment delays outweigh the potential benefit of a separate CTP scan. |
| first_indexed | 2024-03-08T22:40:46Z |
| format | Article |
| id | doaj.art-caa8a13407704a3985a51873ed07bf8b |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-08T22:40:46Z |
| publishDate | 2023-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-caa8a13407704a3985a51873ed07bf8b2023-12-17T12:12:30ZengNature PortfolioScientific Reports2045-23222023-12-0113111210.1038/s41598-023-48832-9Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumesKevin J. Chung0Sachin K. Pandey1Alexander V. Khaw2Ting-Yim Lee3Department of Medical Biophysics, The University of Western OntarioDepartment of Medical Imaging, The University of Western OntarioDepartment of Clinical Neurological Sciences, The University of Western OntarioDepartment of Medical Biophysics, The University of Western OntarioAbstract The complexity of CT perfusion (CTP) acquisition protocols may limit the availability of target mismatch assessment at resource-limited hospitals. We compared CTP mismatch with a mismatch surrogate generated from a simplified dynamic imaging sequence comprising widely available non-contrast CT (NCCT) and multiphase CT angiography (mCTA). Consecutive patients with anterior circulation acute ischemic stroke who received NCCT, mCTA, and CTP were retrospectively included in this study. An mCTA-perfusion (mCTA-P) dynamic series was formed by co-registering NCCT and mCTA. We simulated an ideal mCTA-P study by down-sampling CTP (dCTP) dynamic images according to mCTA timing. Ischemic core and penumbra volumes were estimated by cerebral blood flow and Tmax thresholding, respectively, on perfusion maps calculated independently for CTP, dCTP, and mCTA-P by deconvolution. Concordance in target mismatch (core < 70 ml, penumbra ≥ 15 ml, mismatch ratio ≥ 1.8) determination by dCTP and mCTA-P versus CTP was assessed. Of sixty-one included patients, forty-six had a CTP target mismatch. Concordance with CTP profiles was 90% and 82% for dCTP and mCTA-P, respectively. Lower mCTA-P concordance was likely from differences in collimation width between NCCT and mCTA, which worsened perfusion map quality due to a CT number shift at mCTA. Moderate diagnostic agreement between CTP and mCTA-P was found and may improve with optimal mCTA scan parameter selection as simulated by dCTP. mCTA-P may be a pragmatic alternative where CTP is unavailable or the risks of additional radiation dose, contrast injections, and treatment delays outweigh the potential benefit of a separate CTP scan.https://doi.org/10.1038/s41598-023-48832-9 |
| spellingShingle | Kevin J. Chung Sachin K. Pandey Alexander V. Khaw Ting-Yim Lee Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes Scientific Reports |
| title | Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| title_full | Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| title_fullStr | Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| title_full_unstemmed | Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| title_short | Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| title_sort | multiphase ct angiography perfusion maps for predicting target mismatch and ischemic lesion volumes |
| url | https://doi.org/10.1038/s41598-023-48832-9 |
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