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

• ROC curve : determine the cutoff value , sensitivity , specificity of FEP for predict HT.. Summary[r]

The diagnostic value of CT perfusion

The diagnostic value of CT perfusion

for prediction hemorrhagic transformation in acute ischemic

stroke patients stroke patients

Radiology Center - Bạch Mai Hospital

Nguyễn Công Tiến, Nguyễn Quang Anh, Lê Hoàng Kiên, Nguyễn Tất Thiện, Lê Chí Công

Nguyễn Thu Hương , Vũ Đăng Lưu

Backgroup

• Stroke is one of leading killer in the world

• Mechanical thrombectomy (MT) is now

recommended treatment for acute ischemic stroke

(AIS)

• Hemorrhagic transformation (HT) is most serius

complication in AIS patients

• Perfusion CT (PCT) usually perform in AIS patients to

select patients under go MT

• Flow extraction production (FEP) derived PCT

represented as the blood barrier permeability & HT ?

To investigate whether FEP can

predict hemorrhagic transformation

in AIS patients treated mechanical

Materials and Methods

Inclusion criteria

• Clinical signs suspected stroke

• CT to confirm no hemorrhage

• CTA, CTP confirm large cerebral artery occlusion

• Under go mechanical thrombectomy

• Following by CT or CHT at 18 - 24 hours after MT

Data analysis y

• Student t-test: to compare the clinical, PCT parameters

between two groups (HT, no HT)

• ROC curve: determine the cutoff value, sensitivity,

CTA, CTP protocol

• MSCT Definition Edge, Siemens

• CT non-contrast: 0.6 mm, 120 KV, 200 mAs

• CT angiography (CTA): 0.6 mm, 120 KV, 160 mAs

• CT perfusion (PCT): 0.6 mm, 100 KV, 80 mAs

(2 phase: total 120 seconds)

First phase: 1.5s / cycle x 30 timesp y

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

• Total radiation dose: 6.2 mSv

• Perfusion stroke software, syngo via, Siemens

Patient characteristics

(n = 47) No HT

(n = 23)

HT (n = 24)

p-value

Male (%) 27/20 (57.4%)

NIHSS 13 (7 – 21) 14 (7 – 22) 0.4

Glasgow 13 (10 – 15) 14 (9 – 15) 0.27

ASPECT 8 (7 – 9) 8 (6 – 9) 0.9

Onset - reperfusion p (min) ( ) 388 ± 219 371 ± 162 0.8

Penumbra (mL) 85 ± 39.4 66.8 ± 30.6 0.08

Infarction (mL) 37.8 ± 25.4 33.4 ± 26 0.6

FEP (mg/mL/100g) 1.02 ± 0.58 1.68 ± 0.84 < 0.01

PRR , Infarction between two groups

HT

HT

No HT HT

No HT

Predict value of FEP for HT

1.41

Cutoff: 1.41 AUC: 0.83 Spe cificity: 96%

Sen sitivity: 67%

Specificity

Multivariate logistic regression analysis

Univariate Multivariate Odds

ratio

95% CI p-value Odds

ratio

95% CI p-value

NIHSS 1.09 0.9 – 1.31 0.4

ASPECTS 0.89 0.37 – 2.13 0.8

Onset-reperfusion (min)

1 0.996 - 1 0.9

Penumbra (mL) 0.98 0.96 - 1 0.1 0.98 0.96 - 1 0.08

Infarction (mL) 0.99 0.96 – 1.02 0.5

PRR (%) 0.99 0.96 - 1.03 0.8

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

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

Multivariate: HT ~ Age + gender + factors with p < 0.2 in univariate

•NIHSS, ASPECTS, Penumbra, PRR,

between two groups

•FEP and Penumbra in HT were

significant higher than those in no HT

•With cutoff value of 1,41 (mg/ml/min) FEP

has sensitivity of 67 %, specificity of

Conclusions

•HT after MT therapy may be predicted by

pretreatment CTP-FEP

p

•FEP may help physicians to select AIS

patients for revascularization therapy to

improve patient outcome

Female 74y, onset 7h, suddenly weakness

1.8 0.3

MIP

PRR: 85%

Male 54y, suddenly weakness, onset 10h

1.80.9 0.3

MIP

PRR: 92%

VRT

0.91 1.49

MIP

Flow extraction production

Male 33y, NIHSS 12, PRR 96%, FEP 1.03

0 61 1 03

MIP Flow extraction

production (FEP) T2*-24h

0.61 1.03

Thank you so much !

Đà Nẵng – Hội An, 2019