Cerebral Blood Flow Predicts the Infarct Core

Author:

Amukotuwa Shalini1,Straka Matus2,Aksoy Didem2,Fischbein Nancy3,Desmond Patricia4,Albers Gregory2,Bammer Roland5

Affiliation:

1. From the Department of Radiology (S.A.), University of Melbourne, Australia

2. Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA (M.S., D.A., G.A.)

3. Stanford University, Stanford, CA (N.F.).

4. Department of Radiology (P.D.), University of Melbourne, Australia

5. Department of Radiology and Florey Department of Neuroscience and Mental Health (R.B.), University of Melbourne, Australia

Abstract

Background and Purpose— The aim of this study is to determine the spatial and volumetric accuracy of infarct core estimates from relative cerebral blood flow (rCBF) by comparison with near-contemporaneous diffusion-weighted imaging (DWI), and evaluate whether it is sufficient for patient triage to reperfusion therapies. Methods— One hundred ninety-three patients enrolled in the DEFUSE 2 (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution) and SENSE 3 (Sensitivity Encoding) stroke studies were screened, and 119 who underwent acute magnetic resonance imaging with DWI and perfusion imaging within 24 hours of onset were included. Infarct core was estimated using reduced rCBF at 12 thresholds (<0.20–<0.44) and compared against DWI (apparent diffusion coefficient <620 10 −6 mm2/s). For each threshold, volumetric agreement between the rCBF and DWI core estimates was assessed using Bland-Altman, correlation, and linear regression analyses; spatial agreement was assessed using receiver operating characteristic analysis. Results— An rCBF threshold of 0.32 yielded the smallest mean absolute volume difference (14.7 mL), best linear regression fit (R 2 =0.84), and best spatial agreement (Youden index, 0.38; 95% CI, 0.34–0.41) between rCBF and DWI, with high correlation ( r =0.91, P <0.05), a small mean volume difference (1.3 mL) and no fixed bias ( P <0.05). At this threshold, 110 of 119 (92.4%) patients were correctly triaged when applying 70 mL as the volume limit for thrombectomy. Spatial agreement was better for prediction of large infarcts (>70 mL) than small infarcts (≤70 mL), with Youden indices of 0.53 (95% CI, 0.49–0.56) and 0.34 (95% CI, 0.30–0.37), respectively. Conclusions— Strong correlation and agreement with near-contemporaneous DWI indicate that infarct core estimates obtained using rCBF are sufficiently accurate for patient triage to reperfusion therapies. The identified optimal rCBF threshold of 0.32 closely approximates the threshold currently used in clinical practice.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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