Dynamic CTA-Derived Perfusion Maps Predict Final Infarct Volume: The Simple Perfusion Reconstruction Algorithm

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FIG 1.
Bland-Altman plots for SPIRAL infarct volume (milliliters) (A) and Tmax infarct volume (milliliters) in cortical gray matter/white matter (i) and basal ganglia (ii). SPIRAL infarct volume (milliliters) (B) and follow-up DWI infarct volume (milliliters) in the cortical gray matter/white matter (i) and basal ganglia (ii). C, Tmax infarct volume and follow-up DWI infarct volume in cortical gray matter/white matter (i) and basal ganglia (ii).
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FIG 2.
Sensitivity for final infarction on 24-h our MR imaging versus lesion size for SPIRAL and the CTP Tmax map.
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FIG 3.
Admission SPIRAL map and CTP Tmax map for 3 patients who underwent EVT for M1 occlusions who had quality/fast reperfusion. The final infarct volume is outlined on the 24-hour DWI.

Table 1:

Admission demographics, site of occlusion, and workflow metrics

Variables	Total (n = 72 Patients)
Age (median) (minimum-maximum) (yr)	68 (32–89)
Men (No.) (%)	37 (51.4)
Stroke on awakening (No.) (%)	27 (46.6)
Site of occlusion (No.) (%)
MCA	29 (40.3)
ACA	3 (4.0)
ICA	16 (22.2)
Tandem	5 (6.9)
Affected hemisphere (No.) (%)
Right	30 (41.7)
Left	39 (54.2)
Coronary artery disease (No.) (%)	12 (16.7)
Congestive heart failure (No.) (%)	6 (8.3)
Valvular disease (No.) (%)	2 (3.4)
Hypertension (No.) (%)	38 (52.8)
Dyslipidemia (No.) (%)	24 (33.3)
Diabetes (No.) (%)	1 (1.4)
Smoking (No.) (%)	20 (27.8)
Statin (No.) (%)	22 (37.9)
EVT treatment (No.) (%)	72 (100)
tPA (alteplase) treatment (No.) (%)	55 (76)
Reperfusion (TICI 2b/3) (No.) (%)	72 (100)
Blood glucose (median) (minimum-maximum) (mmol)	6 (4.4–20.0)
NIHSS baseline (median) (minimum-maximum)	17 (1–29)
NIHSS 24 hours (median) (minimum-maximum)	6 (0–24)
MR spectroscopy baseline (median) (minimum-maximum)	0 (0–3)
MR spectroscopy (median) (minimum-maximum) (90 days)	2 (0–6)
CT to reperfusion time (median) (minimum-maximum) (hh:mm)	1:28 (0:27–3:06)

Table 2:

ROC curve AUC for SPIRAL map, stratified by CT-to-reperfusion time for cortical gray and white matter tissue

Statistic	AUC, Patient Level	AUC, Cohort Level	Cross-Validation Sensitivity	Cross-Validation Specificity	Cross-Validation Accuracy
Early reperfusion, <90 minutes (n = 48 patients)
Mean	0.83	0.82	0.82	0.72	0.77
SD	0.14	NA	0.06	0.03	0.06
Late reperfusion, >90 minutes (n = 24 patients)
Mean	0.84	0.81	0.79	0.70	0.74
SD	0.11	NA	0.08	0.06	0.07

Table 3:

ROC curve AUC for SPIRAL map, stratified by CT-to-reperfusion time for basal ganglia regions

Statistic	AUC, Patient Level	AUC, Cohort Level	Cross-Validation Sensitivity	Cross-Validation Specificity	Cross-Validation Accuracy
Early reperfusion, >90 minutes (21 patients)
Mean	0.82	0.81	0.82	0.81	0.82
SD	0.11	NA	0.05	0.06	0.06
Late reperfusion, <90 minutes (7 patients)
Mean	0.84	0.80	0.86	0.71	0.78
SD	0.1	NA	0.08	0.09	0.09

Table 4:

ROC curve AUC for SPIRAL map comparison with cine CTP maps for a 40-patient subcohort

Statistic	Cortical GM and White Matter (WM)	Basal Ganglia
SPIRAL map
AUC, patient level (mean) (SD)	0.83 (0.14)	0.79 (0.08)
AUC, cohort level (mean)	0.82	0.80
CTP T-max map
AUC, patient level	0.82 (0.13)	0.78 (0.11)
AUC, cohort level	0.81	0.74
CTP blood flow map
AUC, patient level	0.74 (0.14)	0.78 (0.09)
AUC, cohort level	0.72	0.77