CT perfusion to measure venous outflow in acute ischemic stroke in patients with a large vessel occlusion
G Adusumilli, S Christensen, N Yuen… - Journal of …, 2024 - jnis.bmj.com
Journal of NeuroInterventional Surgery, 2024•jnis.bmj.com
Background Robust venous outflow (VO) profiles, measured by degree of venous
opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated
with favorable outcomes in patients with large vessel occlusion acute ischemic stroke
treated by thrombectomy. However, VO measurements are laborious and require
neuroimaging expertise. Objective To develop a semi-automated method to measure VO
using CTA and CT perfusion imaging studies. Methods We developed a graphical interface …
opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated
with favorable outcomes in patients with large vessel occlusion acute ischemic stroke
treated by thrombectomy. However, VO measurements are laborious and require
neuroimaging expertise. Objective To develop a semi-automated method to measure VO
using CTA and CT perfusion imaging studies. Methods We developed a graphical interface …
Background
Robust venous outflow (VO) profiles, measured by degree of venous opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated with favorable outcomes in patients with large vessel occlusion acute ischemic stroke treated by thrombectomy. However, VO measurements are laborious and require neuroimaging expertise.
Objective
To develop a semi-automated method to measure VO using CTA and CT perfusion imaging studies.
Methods
We developed a graphical interface using The Visualization Toolkit, allowing for voxel selection at the confluence and bilateral internal cerebral veins on CTA along with arterial input functions (AIFs) from both internal carotid arteries. We extracted concentration–time curves from the CT perfusion study at the corresponding locations associated with AIF and venous output function (VOF). Outcome analyses were primarily conducted by the Mann-Whitney U and Jonckheere-Terpstra tests.
Results
Segmentation at the pre-selected AIF and VOF locations was performed on a sample of 97 patients. 65 patients had favorable VO (VO+) and 32 patients had unfavorable VO (VO−). VO+ patients were found to have a significantly shorter VOF time to peak (8.26; 95% CI 7.07 to 10.34) than VO− patients (9.44; 95% CI 8.61 to 10.91), P=0.007. No significant difference was found in VOF curve width and the difference in time between AIF and VOF peaks.
Conclusions
Time to peak of VOF at the confluence of sinuses was significantly associated with manually scored venous outflow. Further studies should aim to understand better the association between arterial inflow and venous outflow, and capture quantitative metrics of venous outflow at other locations.
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