Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNEUROVASCULAR/STROKE IMAGING

Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization

Alexander Rau, Marco Reisert, Christian A. Taschner, Theo Demerath, Samer Elsheikh, Benedikt Frank, Martin Köhrmann, Horst Urbach and Elias Kellner
American Journal of Neuroradiology February 2024, DOI: https://doi.org/10.3174/ajnr.A8111
Alexander Rau
aFrom the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
bDepartment of Diagnostic and Interventional Radiology (A.R.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Alexander Rau
Marco Reisert
cMedical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
dDepartment of Stereotactic and Functional Neurosurgery (M.R.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Marco Reisert
Christian A. Taschner
aFrom the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Theo Demerath
aFrom the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Theo Demerath
Samer Elsheikh
aFrom the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Samer Elsheikh
Benedikt Frank
eDepartment of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Köhrmann
eDepartment of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Martin Köhrmann
Horst Urbach
aFrom the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Horst Urbach
Elias Kellner
cMedical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Elias Kellner
  • Article
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

REFERENCES

  1. 1.↵
    1. Demeestere J,
    2. Wouters A,
    3. Christensen S, et al
    . Review of perfusion imaging in acute ischemic stroke. Stroke 2020;51:1017–24 doi:10.1161/STROKEAHA.119.028337 pmid:32008460
    CrossRefPubMed
  2. 2.↵
    1. Albers GW,
    2. Marks MP,
    3. Kemp S
    , DEFUSE 3 Investigators, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708–18 doi:10.1056/NEJMoa1713973 pmid:29364767
    CrossRefPubMed
  3. 3.↵
    1. Nogueira RG,
    2. Jadhav AP,
    3. Haussen DC
    , DAWN Trial Investigators, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21 doi:10.1056/NEJMoa1706442 pmid:29129157
    CrossRefPubMed
  4. 4.↵
    1. Powers WJ,
    2. Rabinstein AA,
    3. Ackerson T, et al
    . Guidelines for the early management of patients with acute ischemic stroke. 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344–e418 doi:10.1161/STR.0000000000000211 pmid:31662037
    CrossRefPubMed
  5. 5.↵
    1. Sarraj A,
    2. Hassan AE,
    3. Abraham MG
    , SELECT2 Investigators, et al. Trial of endovascular thrombectomy for large ischemic strokes. N Engl J Med 2023;388:1259–71 doi:10.1056/NEJMoa2214403 pmid:36762865
    CrossRefPubMed
  6. 6.↵
    1. Huo X,
    2. Ma G,
    3. Tong X
    , ANGEL-ASPECT Investigators, et al. Trial of endovascular therapy for acute ischemic stroke with large infarct. N Engl J Med 2023;388:1272–83 doi:10.1056/NEJMoa2213379 pmid:36762852
    CrossRefPubMed
  7. 7.↵
    1. Konstas AA,
    2. Goldmakher GV,
    3. Lee TY, et al
    . Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke: 1. Theoretic basis. AJNR Am J Neuroradiol 2009;30:662–68 doi:10.3174/ajnr.A1487 pmid:19270105
    Abstract/FREE Full Text
  8. 8.↵
    1. Olivot JM,
    2. Mlynash M,
    3. Inoue M
    , DEFUSE 2 Investigators, et al. Hypoperfusion intensity ratio predicts infarct progression and functional outcome in the DEFUSE 2 cohort. Stroke 2014;45:1018–23 doi:10.1161/STROKEAHA.113.003857 pmid:24595591
    Abstract/FREE Full Text
  9. 9.↵
    1. Campbell BC,
    2. Christensen S,
    3. Levi CR, et al
    . Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 2011;42:3435–40 doi:10.1161/STROKEAHA.111.618355 pmid:21980202
    Abstract/FREE Full Text
  10. 10.↵
    1. Falcao AL,
    2. Reutens DC,
    3. Markus R, et al
    . The resistance to ischemia of white and gray matter after stroke. Ann Neurol 2004;56:695–701 doi:10.1002/ana.20265 pmid:15505775
    CrossRefPubMed
  11. 11.↵
    1. Chen C,
    2. Bivard A,
    3. Lin L, et al
    . Thresholds for infarction vary between gray matter and white matter in acute ischemic stroke: a CT perfusion study. J Cereb Blood Flow Metab 2019;39:536–46 doi:10.1177/0271678X17744453 pmid:29172990
    CrossRefPubMed
  12. 12.↵
    1. Arakawa S,
    2. Wright PM,
    3. Koga M, et al
    . Ischemic thresholds for gray and white matter: a diffusion and perfusion magnetic resonance study. Stroke 2006;37:1211–16 doi:10.1161/01.STR.0000217258.63925.6b pmid:16574931
    Abstract/FREE Full Text
  13. 13.↵
    1. Marstrand JR,
    2. Garde E,
    3. Rostrup E, et al
    . Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities. Stroke 2002;33:972–76 doi:10.1161/01.str.0000012808.81667.4b pmid:11935046
    Abstract/FREE Full Text
  14. 14.↵
    1. Shi Y,
    2. Thrippleton MJ,
    3. Makin SD, et al
    . Cerebral blood flow in small vessel disease: a systematic review and meta-analysis. J Cereb Blood Flow Metab 2016;36:1653–67 doi:10.1177/0271678X16662891 pmid:27496552
    CrossRefPubMed
  15. 15.↵
    1. Hoving JW,
    2. Marquering HA,
    3. Majoie CB, et al
    . Volumetric and spatial accuracy of computed tomography perfusion estimated ischemic core volume in patients with acute ischemic stroke. Stroke 2018;49:2368–75 doi:10.1161/STROKEAHA.118.020846 pmid:30355095
    CrossRefPubMed
  16. 16.↵
    1. Boned S,
    2. Padroni M,
    3. Rubiera M, et al
    . Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg 2017;9:66–69 doi:10.1136/neurintsurg-2016-012494 pmid:27566491
    Abstract/FREE Full Text
  17. 17.↵
    1. Martins N,
    2. Aires A,
    3. Mendez B, et al
    . Ghost infarct core and admission computed tomography perfusion: redefining the role of neuroimaging in acute ischemic stroke. Interv Neurol 2018;7:513–21 doi:10.1159/000490117 pmid:30410531
    CrossRefPubMed
  18. 18.↵
    1. Rodrigues GM,
    2. Mohammaden MH,
    3. Haussen DC, et al
    . Ghost infarct core following endovascular reperfusion: a risk for computed tomography perfusion misguided selection in stroke. Int J Stroke 2021 Nov 19 [Epub ahead of print] doi:10.1177/17474930211056228 pmid:34796765
    CrossRefPubMed
  19. 19.↵
    1. Ballout AA,
    2. Oh SY,
    3. Huang B, et al
    . Ghost infarct core: a systematic review of the frequency, magnitude, and variables of CT perfusion overestimation. J Neuroimaging 2023;33:716–24 doi:10.1111/jon.13127 pmid:37248074
    CrossRefPubMed
  20. 20.↵
    1. Fazekas F,
    2. Chawluk JB,
    3. Alavi A, et al
    . MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 1987;149:351–56 doi:10.2214/ajr.149.2.351 pmid:3496763
    CrossRefPubMedWeb of Science
  21. 21.↵
    1. Lin L,
    2. Bivard A,
    3. Krishnamurthy V, et al
    . Whole-brain CT perfusion to quantify acute ischemic penumbra and core. Radiology 2016;279:876–87 doi:10.1148/radiol.2015150319 pmid:26785041
    CrossRefPubMed
  22. 22.↵
    1. Olivot JM,
    2. Mlynash M,
    3. Thijs VN, et al
    . Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke 2009;40:469–75 doi:10.1161/STROKEAHA.108.526954 pmid:19109547
    Abstract/FREE Full Text
  23. 23.↵
    1. Psychogios MN,
    2. Sporns PB,
    3. Ospel J, et al
    . Automated perfusion calculations vs. visual scoring of collaterals and CBV-ASPECTS: has the machine surpassed the eye? Clin Neuroradiol 2021;31:499–506
    CrossRefPubMed
  24. 24.↵
    1. Kellner E,
    2. Urbach H
    . Machine outputs must be checked. Clin Neuroradiol 2021;31:507–08 doi:10.1007/s00062-021-01012-6 pmid:33835191
    CrossRefPubMed
  25. 25.↵
    1. Amukotuwa S,
    2. Straka M,
    3. Aksoy D, et al
    . Cerebral blood flow predicts the infarct core: new insights from contemporaneous diffusion and perfusion imaging. Stroke 2019;50:2783–89 doi:10.1161/STROKEAHA.119.026640 pmid:31462191
    CrossRefPubMed
  26. 26.↵
    1. Veldsman M,
    2. Kindalova P,
    3. Husain M, et al
    . Spatial distribution and cognitive impact of cerebrovascular risk-related white matter hyperintensities. Neuroimage Clin 2020;28:102405 doi:10.1016/j.nicl.2020.102405 pmid:32971464
    CrossRefPubMed
  27. 27.↵
    1. Kellner E,
    2. Rau A,
    3. Demerath T, et al
    . Contrast bolus interference in a multimodal CT stroke protocol. AJNR Am J Neuroradiol 2021;42:1807–14 doi:10.3174/ajnr.A7247 pmid:34413063
    Abstract/FREE Full Text
  28. 28.↵
    1. Georgakis MK,
    2. Duering M,
    3. Wardlaw JM, et al
    . WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis. Neurology 2019;92:e1298–308 doi:10.1212/WNL.0000000000007142 pmid:30770431
    CrossRefPubMed
  29. 29.↵
    1. Bristow MS,
    2. Simon JE,
    3. Brown RA, et al
    . MR perfusion and diffusion in acute ischemic stroke: human gray and white matter have different thresholds for infarction. J Cereb Blood Flow Metab 2005;25:1280–87 doi:10.1038/sj.jcbfm.9600135 pmid:15889043
    CrossRefPubMedWeb of Science
  30. 30.↵
    1. Schaefer PW,
    2. Roccatagliata L,
    3. Ledezma C, et al
    . First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiol 2006;27:20–25 pmid:16418350
    PubMed
  31. 31.↵
    1. Eilaghi A,
    2. d’Esterre CD,
    3. Lee TY, et al
    . Toward patient-tailored perfusion thresholds for prediction of stroke outcome. AJNR Am J Neuroradiol 2014;35:472–77 doi:10.3174/ajnr.A3740 pmid:24113471
    Abstract/FREE Full Text
  32. 32.↵
    1. d’Esterre CD,
    2. Boesen ME,
    3. Ahn SH, et al
    . Time-dependent computed tomographic perfusion thresholds for patients with acute ischemic stroke. Stroke 2015;46:3390–97 doi:10.1161/STROKEAHA.115.009250 pmid:26514186
    Abstract/FREE Full Text
  33. 33.↵
    1. Clèrigues A,
    2. Valverde S,
    3. Bernal J, et al
    . Acute ischemic stroke lesion core segmentation in CT perfusion images using fully convolutional neural networks. Comput Biol Med 2019;115:103487 doi:10.1016/j.compbiomed.2019.103487 pmid:31629272
    CrossRefPubMed
  34. 34.↵
    1. Rava RA,
    2. Podgorsak AR,
    3. Waqas M, et al
    . Investigation of convolutional neural networks using multiple computed tomography perfusion maps to identify infarct core in acute ischemic stroke patients. J Med Imaging (Bellingham) 2021;8:014505 doi:10.1117/1.JMI.8.1.014505 pmid:33585662
    CrossRefPubMed
  35. 35.↵
    1. Soltanpour M,
    2. Greiner R,
    3. Boulanger P, et al
    . Improvement of automatic ischemic stroke lesion segmentation in CT perfusion maps using a learned deep neural network. Comput Biol Med 2021;137:104849 doi:10.1016/j.compbiomed.2021.104849 pmid:34530336
    CrossRefPubMed
  36. 36.↵
    1. Werdiger F,
    2. Parsons MW,
    3. Visser M, et al
    . Machine learning segmentation of core and penumbra from acute stroke CT perfusion data. Front Neurol 2023;14:1098562 doi:10.3389/fneur.2023.1098562 pmid:36908587
    CrossRefPubMed
  37. 37.↵
    1. Shi T,
    2. Jiang H,
    3. Zheng B
    . C2MA-Net: cross-modal cross-attention network for acute ischemic stroke lesion segmentation based on CT perfusion scans. IEEE Trans Biomed Eng 2022;69:108–18 doi:10.1109/TBME.2021.3087612 pmid:34101581
    CrossRefPubMed
PreviousNext
Back to top
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
Alexander Rau, Marco Reisert, Christian A. Taschner, Theo Demerath, Samer Elsheikh, Benedikt Frank, Martin Köhrmann, Horst Urbach, Elias Kellner
Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization
American Journal of Neuroradiology Feb 2024, DOI: 10.3174/ajnr.A8111

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization
Alexander Rau, Marco Reisert, Christian A. Taschner, Theo Demerath, Samer Elsheikh, Benedikt Frank, Martin Köhrmann, Horst Urbach, Elias Kellner
American Journal of Neuroradiology Feb 2024, DOI: 10.3174/ajnr.A8111
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • IVIM MRI in the Ischemic Penumbra
  • DMV, IFS and CSVD burden
  • Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
Show more Neurovascular/Stroke Imaging

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire