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Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke

  • Diagnostic Neuroradiology
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Abstract

Introduction

The aim of this study was to examine reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke who underwent recently introduced whole-brain CT perfusion (WB-CTP).

Methods

Twenty-five consecutive patients underwent 128-row WB-CTP with extended scan coverage of 100 mm in the z-axis using adaptive spiral scanning technique. Volumetric analysis of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP), and time to drain (TTD) was performed twice by two blinded and experienced readers using OsiriX V.4.0 imaging software. Interreader agreement and intrareader agreement were assessed by intraclass correlation coefficients (ICCs) and Bland–Altman Analysis.

Results

Interreader agreement was highest for TTD (ICC 0.982), followed by MTT (0.976), CBF (0.955), CBV (0.933), and TTP (0.865). Intrareader agreement was also highest for TTD (ICC 0.993), followed by MTT (0.988), CBF (0.981), CBV (9.953), and TTP (0.927). The perfusion deficits showed the highest absolute volumes in the time-related parametric maps TTD (mean volume 121.4 ml), TTP (120.0 ml), and MTT (112.6 ml) and did not differ significantly within this group (each with p > 0.05). In comparison to time-related maps, the mean CBF perfusion deficit volume was significantly smaller (92.1 ml, each with p < 0.05). The mean CBV lesion size was 23.4 ml.

Conclusions

Volumetric assessment in WB-CTP is reliable and reproducible. It might serve for a more accurate assessment of stroke outcome prognosis and definition of flow-volume mismatch. Time to drain showed the highest agreement and therefore might be an interesting parameter to define tissue at risk.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Institute of Clinical Radiology, University of Munich Hospitals, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany

    Kolja M. Thierfelder, Wieland H. Sommer, Alena B. Baumann, Felix G. Meinel, Frederik F. Strobl, Konstantin Nikolaou & Maximilian F. Reiser

  2. Siemens Healthcare Sector, University of Erlangen-Nuremberg, Erlangen, Germany

    Ernst Klotz

  3. Department of Neurology, University of Munich Hospitals, Grosshadern Campus, Munich, Germany

    Louisa von Baumgarten

Authors
  1. Kolja M. Thierfelder
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  2. Wieland H. Sommer
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  3. Alena B. Baumann
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  4. Ernst Klotz
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  5. Felix G. Meinel
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  6. Frederik F. Strobl
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  7. Konstantin Nikolaou
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  8. Maximilian F. Reiser
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  9. Louisa von Baumgarten
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Corresponding author

Correspondence to Kolja M. Thierfelder.

Additional information

KMT and WHS contributed equally to this study and the manuscript.

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Thierfelder, K.M., Sommer, W.H., Baumann, A.B. et al. Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke. Neuroradiology 55, 827–835 (2013). https://doi.org/10.1007/s00234-013-1179-0

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  • DOI: https://doi.org/10.1007/s00234-013-1179-0

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