thediagnosticvalueofctperfusionthe diagnostic value of ct perfusion for prediction hemorrhagic transformation in acute ischemic strokepatientsstroke patients

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<b>The diagnostic value of CT perfusion</b>

<b>The diagnostic value of CT perfusion </b>

<b>for prediction hemorrhagic </b>

<b>transformation in acute ischemic </b>

<b>stroke patients</b>

<b>stroke patients </b>

Radiology Center - Bạch Mai Hospital

Nguyễn Cơng Tiến, Nguyễn Quang Anh, Lê Hồng Kiên, Nguyễn Tất Thiện, Lê Chí Cơng
Nguyễn Thu Hương , Vũ Đăng Lưu

<b>Backgroup</b>

•

<b>Stroke </b>

is one of leading killer in the world

•

<b>Mechanical thrombectomy</b>

(

<b>MT</b>

) is now

d d t

t

t f

<b>t i</b>

<b>h</b>

<b>i</b>

<b>t</b>

<b>k</b>

recommended treatment for

<b>acute ischemic stroke</b>

(

<b>AIS</b>

)

•

<b>Hemorrhagic transformation </b>

(

<b>HT</b>

) is most serius

complication in

<b>AIS</b>

patients

• Perfusion CT (

<b>PCT</b>

) usually perform in AIS patients to

select patients under go

<b>MT</b>

•

<b>Flow extraction production </b>

(

<b>FEP</b>

) derived PCT

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<b>Purpose</b>

To investigate whether

<b>FEP</b>

can

predict

<b>hemorrhagic transformation</b>

in

<b>AIS</b>

patients treated

<b>mechanical </b>

<b>thrombectomy</b>

?

<b>Materials and Methods</b>



<b>Inclusion criteria</b>

• <b>Clinical signs </b>suspected <b>stroke</b>
• <b>CT</b> to confirm <b>no hemorrhage</b>
• <b>CT </b>to confirm <b>no hemorrhage</b>

• <b>CTA, CTP</b> confirm large cerebral artery occlusion
• Under go mechanical thrombectomy

• Following by <b>CT</b> or <b>CHT</b> at 18 - 24 hours after MT



<b>Data analysis</b>

<b>y</b>

• <b>Student t-test:</b> to <b>compare the clinical</b>, <b>PCT parameters </b>
between two groups (HT, no HT)

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<b>CTA, CTP protocol</b>

•

<b>MSCT Definition Edge</b>

,

<b>Siemens</b>

•

<b>CT </b>

non-contrast:

<b>0.6 </b>

mm,

<b>120 </b>

KV,

<b>200 </b>

mAs

•

<b>CT angiography</b>

(

<b>CTA</b>

):

<b>0.6</b>

mm,

<b>120</b>

KV,

<b>160</b>

mAs

•

<b>CT perfusion </b>

(

<b>PCT</b>

):

<b>0.6 </b>

mm,

<b>100 </b>

KV,

<b>80 </b>

mAs

(

<b>2 phase</b>

: total

<b>120 seconds</b>

)

First phase: p <b>1.5s </b>/ cycle x y <b>30</b> times

Delay phase: <b>15s </b>/ cycle x <b>1</b> time <b>+ 30s </b>/ cycle x <b>2</b> times

• Total radiation dose:

<b>6.2 </b>

mSv

•

<b>Perfusion stroke </b>

software,

<b>syngo via, Siemens</b>

<b>Patient characteristics</b>

<b>(n = 47)</b> <b>No HT</b>

<b>(n = 23)</b>

<b>HT</b>
<b>(n = 24)</b>

<i><b>p-value</b></i>

<b>Age </b>(years) 63 ± 14 66 ± 13 0.3
<b>Male </b>(%) 27/20 (57.4%)

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<b>PRR</b>

,

<b>Infarction</b>

between two groups

L)
<i><b>ns</b></i> <i><b>ns</b></i>

<b>PRR</b>

(%)

<b>farction </b>

(m
L

<b>HT</b>

<b>No HT</b>

<b>_{No HT}</b>

<b>_HT</b>

<b>In</b>

<b>f</b>

<b>Penumbra</b>

,

<b>FEP</b>

between two groups

0g)

L)

<i><b>p = 0.08</b></i> <i><b>p < 0.01</b></i>

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Predict value of

<b>FEP </b>

for

<b>HT</b>

<b>1.41</b>

<b>Cutoff: 1.41</b>

<b>AUC: 0.83</b>

<b>Spe</b>

cificity

<b>: 96%</b>

<b>Sen</b>

sitivity

<b>: 67%</b>

<b>Sensitivity</b>

<b>_Sen</b>

sitivity

<b>_{: 67%}</b>

<b>Specificity</b>

<b>Multivariate logistic regression analysis</b>

<b>Univariate</b> <b>Multivariate</b>
<b>Odds </b>

<b>ratio</b>

<b>95% CI</b> <i><b>p-value</b></i> <b>Odds </b>
<b>ratio</b>

<b>95% CI</b> <i><b>p-value</b></i>

<b>ratio</b> <b>ratio</b>

<b>NIHSS</b> 1.09 0.9 – 1.31 0.4
<b>ASPECTS</b> 0.89 0.37 – 2.13 0.8
<b></b>

<b>Onset-reperfusion </b>(min)

1 0.996 - 1 0.9

<b>Penumbra </b>(mL) <b>0.98</b> <b>0.96 - 1</b> <b>0.1</b> <b>0.98</b> <b>0.96 - 1</b> <i><b>0.08</b></i>

<b>Infarction </b>(mL) 0.99 0.96 – 1.02 0.5

<b>PRR </b>(%) 0.99 0.96 - 1.03 0.8

<b>FEP</b>(mg/mL/100g) <b>7.01</b> <b>1.6 – 30.8</b> <i><b>0.009</b></i> <b>9.21</b> <b>1.7 - 50</b> <i><b>0.01</b></i>

Univariate: HT ~ NIHSS, ASPECTS, onset to reperfusion, penumbra, infarction, PRR, FEP.

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<b>Summary</b>

•

<b>NIHSS</b>

,

<b>ASPECTS</b>

,

<b>Penumbra</b>

,

<b>PRR</b>

,

<b>Age</b>

<b>g</b>

,

,

<b>gender</b>

<b>g</b>

were

<b>not difference </b>

between

<b>two groups</b>

•

<b>FEP </b>

and

<b>Penumbra</b>

in

<b>HT</b>

were

<b>significant higher </b>

than those in

<b>no HT</b>

•With cutoff value of

<b>1,41 </b>

(mg/ml/min)

<b>FEP</b>

has

<b>sensitivity of 67 %</b>

,

<b>specificity of </b>

<b>96% </b>

for predict

<b>HT</b>

<b>Conclusions</b>

•

<b>HT</b>

after

<b>MT </b>

therapy may be predicted by

pretreatment CTP-

<b>FEP</b>

p

•

<b>FEP</b>

may

<b>help</b>

physicians to

<b>select AIS</b>

<b>patients</b>

for

<b>revascularization therapy </b>

to

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<b>Female 74y, onset 7h, suddenly weakness</b>

1.8 0.3

<b>MIP</b>

<b>CBF</b>

<b>CBV</b>

<b>FEP</b>

<b>T2*-24h</b>

<b>PRR: 85%</b>

<b>Male 54y, suddenly weakness, onset 10h </b>

<b>CBF</b>

<b>CBV</b>

<b>FEP</b>

<b>T2*-24h</b>

1.8<b>0.9</b> 0.3

<b>MIP</b>

<b>CBF</b>

<b>CBV</b>

<b>FEP</b>

<b>T2 -24h</b>

<b>PRR: 92%</b>

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0.91
1.49

<b>MIP</b>

Flow extraction production

<b>(FEP)</b> <b>T2*-24h </b>

Male 33y, NIHSS

<b>12</b>

, PRR

<b>96%</b>

, FEP

<b>1.03</b>

0 61 1 03

<b>MIP</b> Flow extraction

production <b>(FEP)</b> <b>T2*-24h </b>

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<i><b>Thank you so much !</b></i>

</div>

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