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Research ArticleAdult Brain
Open Access

Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds

A. Rodríguez-Vázquez, C. Laredo, A. Renú, S. Rudilosso, L. Llull, S. Amaro, V. Obach, V. Vera, A. Páez, L. Oleaga, X. Urra and Á. Chamorro
American Journal of Neuroradiology August 2022, DOI: https://doi.org/10.3174/ajnr.A7601
A. Rodríguez-Vázquez
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
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C. Laredo
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
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A. Renú
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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S. Rudilosso
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
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L. Llull
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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S. Amaro
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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V. Obach
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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V. Vera
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
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A. Páez
bRadiology Department (A.P., L.O.), Hospital Clínic, Barcelona, Spain
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L. Oleaga
bRadiology Department (A.P., L.O.), Hospital Clínic, Barcelona, Spain
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X. Urra
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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Á. Chamorro
aFrom the Comprehensive Stroke Center (A.R.-V., C.L., A.R., S.R., L.L., S.A., V.O., V.V., X.U., A.C.), Functional Unit of Cerebrovascular Diseases
cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (A.R., S.R., L.L., S.A., V.O., X.U., A.C.), Barcelona, Spain
dUniversity of Barcelona (A.R., L.L. S.A., V.O., X.U., A.C.), Barcelona, Spain
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Figures

  • FIG 1.
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    FIG 1.

    Segmentation methodology for calculating WM- and WM-specific rCBF thresholds. MNI indicates Montreal Neurological Institute.

  • FIG 2.
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    FIG 2.

    Distribution of rCBF thresholds for the infarct core prediction in the whole brain (dark gray), GM (light gray), and WM (white). The left image (A) represents the net infarct volume difference, and the right image (B) shows the ICC. Boxplots represent median (horizontal line in the inner box) 25% and 75% IQRs.

  • FIG 3.
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    FIG 3.

    Receiver operating characteristic curves showing the performance of the application of different global GM- and WM-specific and combined rCBF thresholds in the voxel-based analysis to predict tissue fate. The area under the curve (AUC) is for the single best threshold, best GM-specific, best WM-specific, and best GM- and WM-specific thresholds combined. No significant differences in the AUC values were found among the different thresholds applied.

  • FIG 4.
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    FIG 4.

    IG-corrected rCBF thresholds for defining infarct core in the whole brain (dark gray), GM (light gray), and WM (white). The left image represents the net infarct volume difference, and the right image shows the ICC (A and B). Accounting for the estimated IG from baseline imaging to complete reperfusion changes the optimal rCBF threshold for defining infarct core (C).

  • FIG 5.
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    FIG 5.

    Heat map of the distribution of false-positives according to the following: the single rCBF 30% threshold most used in clinical practice (A) and a variable threshold in WM (rCBF 20%) and GM (rCBF 35%) (B). Warmer colors indicate a greater absolute accumulation of cases, while colder colors mean a lower absolute number of cases.

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Cite this article
A. Rodríguez-Vázquez, C. Laredo, A. Renú, S. Rudilosso, L. Llull, S. Amaro, V. Obach, V. Vera, A. Páez, L. Oleaga, X. Urra, Á. Chamorro
Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds
American Journal of Neuroradiology Aug 2022, DOI: 10.3174/ajnr.A7601

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Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds
A. Rodríguez-Vázquez, C. Laredo, A. Renú, S. Rudilosso, L. Llull, S. Amaro, V. Obach, V. Vera, A. Páez, L. Oleaga, X. Urra, Á. Chamorro
American Journal of Neuroradiology Aug 2022, DOI: 10.3174/ajnr.A7601
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