Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke

Background and purpose: Leukoaraiosis frequently coexists in patients with acute stroke. We studied whether leukoaraiosis could confound the interpretation of CTP findings in patients treated with mechanical thrombectomy. Materials and methods: We analyzed 236 patients with stroke treated with mecha...

Descripción completa

Detalles Bibliográficos
Autores: Rudilosso, Salvatore, Laredo Gregorio, Carlos, Vivancos Sánchez, Catalina, Urra, Xabier, Llull Estrany, Laura, Renú, Arturo, Obach, Víctor, Zhao, Yashu, Moreno, Javier, Lopez-Rueda, Antonio, Amaro Delgado, Sergio, Chamorro Sánchez, Ángel
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/228001
Acceso en línea:https://hdl.handle.net/2445/228001
Access Level:acceso abierto
Palabra clave:Malalties cerebrovasculars
Cerebrovascular disease
id ES_e655869b1e094c0abc41bbdbe4fd0cba
oai_identifier_str oai:diposit.ub.edu:2445/228001
network_acronym_str ES
network_name_str España
repository_id_str
spelling Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic StrokeRudilosso, SalvatoreLaredo Gregorio, CarlosVivancos Sánchez, CatalinaUrra, Xabier Llull Estrany, LauraRenú, Arturo Obach, Víctor Zhao, YashuMoreno, JavierLopez-Rueda, AntonioAmaro Delgado, SergioChamorro Sánchez, ÁngelMalalties cerebrovascularsCerebrovascular diseaseBackground and purpose: Leukoaraiosis frequently coexists in patients with acute stroke. We studied whether leukoaraiosis could confound the interpretation of CTP findings in patients treated with mechanical thrombectomy. Materials and methods: We analyzed 236 patients with stroke treated with mechanical thrombectomy and studied with CTP, of whom 127 (53.8%) achieved complete reperfusion. Periventricular white matter hyperintensities on MR imaging and hypodensities on NCCT were assessed through the Fazekas score. CTP-predicted nonviable tissue was defined as relative CBF <30%, and final infarct volume was quantified in DWI. We estimated mean MTT, CBV, and CBF in the asymptomatic hemisphere. In patients achieving complete reperfusion, we assessed the accuracy of nonviable tissue to predict final infarct volume using the intraclass correlation coefficient across periventricular hyperintensity/hypodensity Fazekas scores and variable relative CBF cutoffs. Results: MTT was longer (Spearman ρ = 0.279, P < .001) and CBF was lower (ρ = -0.263, P < .001) as the periventricular hyperintensity Fazekas score increased, while CBV was similar across groups (ρ = -0.043, P = .513). In the subgroup of patients achieving complete reperfusion, nonviable tissue-final infarct volume reliability was excellent in patients with periventricular hyperintensity Fazekas score grade 0 (intraclass correlation coefficient, 0.900; 95% CI, 0.805-0.950), fair in patients with periventricular hyperintensity Fazekas scores 1 (intraclass correlation coefficient, 0.569; 95% CI, 0.327-0.741) and 2 (intraclass correlation coefficient, 0.444; 95% CI, 0.165-0.657), and poor in patients with periventricular hyperintensity Fazekas score 3 (intraclass correlation coefficient, 0.310; 95% CI, -0.359-0.769). The most accurate cutoffs were relative CBF <30% for periventricular hyperintensity Fazekas score grades 0 and 1, relative CBF <25% for periventricular hyperintensity Fazekas score 2, and relative CBF <20% for periventricular hyperintensity Fazekas score 3. The reliability analysis according to periventricular hypodensity Fazekas score grades on NCCT was similar to that in follow-up MR imaging. Conclusions: In patients with stroke, the presence of leukoaraiosis confounds the interpretation of CTP despite proper adjustment of CBF thresholds.Lippincott, Williams & Wilkins2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/228001Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3174/ajnr.A6139American Journal of Neuroradiology, 2019, vol. 40, num.8, p. 1323-1329https://doi.org/10.3174/ajnr.A6139(c) Lippincott, Williams & Wilkins, 2019info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2280012026-05-27T06:46:51Z
dc.title.none.fl_str_mv Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
title Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
spellingShingle Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
Rudilosso, Salvatore
Malalties cerebrovasculars
Cerebrovascular disease
title_short Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
title_full Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
title_fullStr Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
title_full_unstemmed Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
title_sort Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke
dc.creator.none.fl_str_mv Rudilosso, Salvatore
Laredo Gregorio, Carlos
Vivancos Sánchez, Catalina
Urra, Xabier
Llull Estrany, Laura
Renú, Arturo
Obach, Víctor
Zhao, Yashu
Moreno, Javier
Lopez-Rueda, Antonio
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author Rudilosso, Salvatore
author_facet Rudilosso, Salvatore
Laredo Gregorio, Carlos
Vivancos Sánchez, Catalina
Urra, Xabier
Llull Estrany, Laura
Renú, Arturo
Obach, Víctor
Zhao, Yashu
Moreno, Javier
Lopez-Rueda, Antonio
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author_role author
author2 Laredo Gregorio, Carlos
Vivancos Sánchez, Catalina
Urra, Xabier
Llull Estrany, Laura
Renú, Arturo
Obach, Víctor
Zhao, Yashu
Moreno, Javier
Lopez-Rueda, Antonio
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malalties cerebrovasculars
Cerebrovascular disease
topic Malalties cerebrovasculars
Cerebrovascular disease
description Background and purpose: Leukoaraiosis frequently coexists in patients with acute stroke. We studied whether leukoaraiosis could confound the interpretation of CTP findings in patients treated with mechanical thrombectomy. Materials and methods: We analyzed 236 patients with stroke treated with mechanical thrombectomy and studied with CTP, of whom 127 (53.8%) achieved complete reperfusion. Periventricular white matter hyperintensities on MR imaging and hypodensities on NCCT were assessed through the Fazekas score. CTP-predicted nonviable tissue was defined as relative CBF <30%, and final infarct volume was quantified in DWI. We estimated mean MTT, CBV, and CBF in the asymptomatic hemisphere. In patients achieving complete reperfusion, we assessed the accuracy of nonviable tissue to predict final infarct volume using the intraclass correlation coefficient across periventricular hyperintensity/hypodensity Fazekas scores and variable relative CBF cutoffs. Results: MTT was longer (Spearman ρ = 0.279, P < .001) and CBF was lower (ρ = -0.263, P < .001) as the periventricular hyperintensity Fazekas score increased, while CBV was similar across groups (ρ = -0.043, P = .513). In the subgroup of patients achieving complete reperfusion, nonviable tissue-final infarct volume reliability was excellent in patients with periventricular hyperintensity Fazekas score grade 0 (intraclass correlation coefficient, 0.900; 95% CI, 0.805-0.950), fair in patients with periventricular hyperintensity Fazekas scores 1 (intraclass correlation coefficient, 0.569; 95% CI, 0.327-0.741) and 2 (intraclass correlation coefficient, 0.444; 95% CI, 0.165-0.657), and poor in patients with periventricular hyperintensity Fazekas score 3 (intraclass correlation coefficient, 0.310; 95% CI, -0.359-0.769). The most accurate cutoffs were relative CBF <30% for periventricular hyperintensity Fazekas score grades 0 and 1, relative CBF <25% for periventricular hyperintensity Fazekas score 2, and relative CBF <20% for periventricular hyperintensity Fazekas score 3. The reliability analysis according to periventricular hypodensity Fazekas score grades on NCCT was similar to that in follow-up MR imaging. Conclusions: In patients with stroke, the presence of leukoaraiosis confounds the interpretation of CTP despite proper adjustment of CBF thresholds.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/228001
url https://hdl.handle.net/2445/228001
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3174/ajnr.A6139
American Journal of Neuroradiology, 2019, vol. 40, num.8, p. 1323-1329
https://doi.org/10.3174/ajnr.A6139
dc.rights.none.fl_str_mv (c) Lippincott, Williams & Wilkins, 2019
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Lippincott, Williams & Wilkins, 2019
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Lippincott, Williams & Wilkins
publisher.none.fl_str_mv Lippincott, Williams & Wilkins
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869422757234606080
score 15,812429

Similares en LA Referencia