What is the impact of head movement on automated CT perfusion mismatch evaluation in acute ischemic stroke?. (22nd July 2021)

• Record Type: Journal Article
• Authors: Potreck, Arne; Seker, Fatih; Mutke, Matthias Anthony; Weyland, Charlotte Sabine; Herweh, Christian; Heiland, Sabine; Bendszus, Martin; Möhlenbruch, Markus
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 6(2022)
• Page Start: 628
• Page End: 633
• Publication Date: 2021-07-22
• Subjects: CT -- stroke -- CT perfusion -- thrombectomy; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2021-017510
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Objectives: Automated CT perfusion mismatch assessment is an established treatment decision tool in acute ischemic stroke. However, the reliability of this method in patients with head motion is unclear. We therefore sought to evaluate the influence of head movement on automated CT perfusion mismatch evaluation. Methods: Using a realistic CT brain-perfusion-phantom, 7 perfusion mismatch scenarios were simulated within the left middle cerebral artery territory. Real CT noise and artificial head movement were added. Thereafter, ischemic core, penumbra volumes and mismatch ratios were evaluated using an automated mismatch analysis software (RAPID, iSchemaView) and compared with ground truth simulated values. Results: While CT scanner noise alone had only a minor impact on mismatch evaluation, a tendency towards smaller infarct core estimates (mean difference of −5.3 (−14 to 3.5) mL for subtle head movement and −7.0 (−14.7 to 0.7) mL for strong head movement), larger penumbral estimates (+9.9 (−25 to 44) mL and +35 (−14 to 85) mL, respectively) and consequently larger mismatch ratios (+0.8 (−1.5 to 3.0) for subtle head movement and +1.9 (−1.3 to 5.1) for strong head movement) were noted in dependence of patient head movement. Conclusions: Motion during CT perfusion acquisition influences automated mismatch evaluation. Potentially treatment-relevant changes in mismatch classifications in dependence of head movement were observed and occurred in favor of mechanical thrombectomy.