on March 2, 2006
Published online before print March 2, 2006, doi: 10.1161/01.STR.0000209238.61459.39
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Submitted on December 14, 2005
From the Department of Radiology, Neuroradiology Section (M.W., W.P.D.), University of California, San Francisco; the Departments of Radiology (V.M., A.Q., S.P.) and Neurology (J.S.), Hospital Doctor Josep Trueta, Girona, Spain; the Departments of Radiology (A.E.F.) and Neurology (C.P.), Thomas Jefferson University Hospital, Philadelphia, Pa; the Department of Radiology (B.V., M.v.L., I.v.d.S., A.W.), University Medical Center Utrecht, The Netherlands; the Departments of Radiology (R.M., P.S.) and Neurology (J.B.), University Hospital (CHUV), Lausanne, Switzerland; the Departments of Radiology (D.G.) and Neurology (I.G.), Rambam Medical Center, Haifa, Israel; the Department of Radiology (J.A., G.N.), Oregon Health and Science University, Portland, Ore; CT Clinical Science (S.P.), Philips Medical Systems, Cleveland, OH; and Medical IT - Advanced Development (M.Q.), Philips Medical Systems, Best, The Netherlands. * To whom correspondence should be addressed. E-mail: Max.Wintermark{at}radiology.ucsf.edu.
Background and Purpose--Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. Methods--One hundred and thirty patients with symptoms suggesting hemispheric stroke Results--The PCT parameter that most accurately describes the tissue at risk of infarction in case of persistent arterial occlusion is the relative MTT (area under the curve=0.962), with an optimal threshold of 145%. The PCT parameter that most accurately describes the infarct core on admission is the absolute CBV (area under the curve=0.927), with an optimal threshold at 2.0 mlx100 g-1. Conclusion--In a large series of 130 patients, the optimal approach to define the infarct and the penumbra is a combined approach using 2 PCT parameters: relative MTT and absolute CBV, with dedicated thresholds.
Accepted on January 10, 2006
Perfusion-CT Assessment of Infarct Core and Penumbra. Receiver Operating Characteristic Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke
Max Wintermark MD*;
12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performed to determine the most accurate PCT parameter, and the optimal threshold for each parameter, using DWI/FLAIR as the gold standard.
Key words: computed tomography • perfusion • ROC analysis • stroke
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