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• W2104157793 abstract "HomeRadiologyVol. 254, No. 1 PreviousNext REVIEWS AND COMMENTARYEDITORIALCT Perfusion Imaging of Acute Stroke: The Need for Arrival Time, Delay Insensitive, and Standardized Postprocessing Algorithms?Angelos A. Konstas , Michael H. LevAngelos A. Konstas , Michael H. LevAuthor Affiliations1From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.Address correspondence to A.A.K. (e-mail: [email protected]).Angelos A. Konstas Michael H. LevPublished Online:Dec 14 2009https://doi.org/10.1148/radiol.09091610MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe study by Kudo et al has demonstrated that software with delay-sensitive deconvolution algorithms overestimate penumbra (ie, mean transit time or cerebral blood flow lesion volume), and consequently final infarct volume, whereas penumbra estimated with delay-insensitive software, and/or with software that used the maximum slope technique, correlates well with final infarct volume.© RSNA, 2009References1 Kudo K, Sasaki M, Yamada K, et al.. Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology 2010;254(1):200–209. Link, Google Scholar2 Saver JL, Gornbein J, Grotta J, et al.. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial. Stroke 2009;40:2433–2437. Crossref, Medline, Google Scholar3 The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587. Crossref, Medline, Google Scholar4 Darby DG, Barber PA, Gerraty RP, et al.. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999;30:2043–2052. Crossref, Medline, Google Scholar5 Neumann-Haefelin T, Wittsack HJ, Wenserski F, et al.. Diffusion- and perfusion-weighted MRI: the DWI/PWI mismatch region in acute stroke. Stroke 1999;30:1591–1597. Crossref, Medline, Google Scholar6 Hacke W, Furlan AJ, Al-Rawi Y, et al.. 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Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke 2009;40:469–475. Crossref, Medline, Google Scholar11 Albers GW, Thijs VN, Wechsler L, et al.. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 2006;60:508–517. Crossref, Medline, Google Scholar12 Donnan GA, Baron JC, Ma H, Davis SM. Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol 2009;8:261–269. Crossref, Medline, Google Scholar13 Sobesky J, Weber OZ, Lehnhardt FG, et al.. Which time-to-peak threshold best identifies penumbral flow? a comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke 2004;35:2843–2847. Crossref, Medline, Google Scholar14 Davis SM, Donnan GA, Parsons MW, et al.. 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Tracer arrival timing-insensitive technique for estimating flow in MR perfusion-weighted imaging using singular value decomposition with a block-circulant deconvolution matrix. Magn Reson Med 2003;50:164–174. Crossref, Medline, Google Scholar19 Wittsack HJ, Wohlschlager AM, Ritzl EK, et al.. CT-perfusion imaging of the human brain: advanced deconvolution analysis using circulant singular value decomposition. Comput Med Imaging Graph 2008;32:67–77. Crossref, Medline, Google Scholar20 Sasaki M, Kudo K, Ogasawara K, Fujiwara S. Tracer delay-insensitive algorithm can improve reliability of CT perfusion imaging for cerebrovascular steno-occlusive disease: comparison with quantitative single-photon emission CT. AJNR Am J Neuroradiol 2009;30:188–193. Crossref, Medline, Google Scholar21 Schaefer PW, Mui K, Kamalian S, Nogueira RG, Gonzalez RG, Lev MH. Avoiding “pseudo-reversibility” of CT-CBV infarct core lesions in acute stroke patients after thrombolytic therapy: the need for algorithmically “delay-corrected” CT perfusion map postprocessing software. Stroke 2009;40:2875–2878. Crossref, Google Scholar22 Christensen S, Mouridsen K, Wu O, et al.. Comparison of 10 perfusion MRI parameters in 97 sub-6-hour stroke patients using voxel-based receiver operating characteristics analysis. Stroke 2009;40:2055–2061. Crossref, Medline, Google Scholar23 Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 2009;30:885–892. Crossref, Medline, Google Scholar24 Wintermark M, Albers GW, Alexandrov AV, et al.. Acute stroke imaging research roadmap. Stroke 2008;39:1621–1628. Crossref, Medline, Google Scholar25 Wintermark M, Albers GW, Alexandrov AV, et al.. Acute stroke imaging research roadmap. 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Crossref, Medline, Google ScholarArticle HistoryReceived August 26, 2009; revision requested September 10; revision received September 22; final version accepted September 23.Published online: Dec 14 2009Published in print: Jan 2010 FiguresReferencesRelatedDetailsCited ByA novel use of time separation technique to improve flat detector CT perfusion imaging in stroke patientsVojtěchKulvait, PhilipHoelter, RobertFrysch, HanaHaseljić, ArndDoerfler, GeorgRose2022 | Medical Physics, Vol. 49, No. 6Stroke in Patients with Left Ventricular Assist DevicesAlyson R.Plecash, DanielleByrne, AlanaFlexman, MustafaToma, Thalia S.Field2022 | Cerebrovascular Diseases, Vol. 51, No. 1Comparison of Accuracy of Arrival-Time-Insensitive and Arrival-Time-Sensitive CTP Algorithms for Prediction of Infarct Tissue VolumesLenhardPennig, FrankThiele, LukasGoertz, Kai RomanLaukamp, MichaelPerkuhn, ChristophKabbasch, MarcSchlamann, Gereon RudolfFink, JanBorggrefe2020 | Scientific Reports, Vol. 10, No. 1An acute stroke CT imaging algorithm incorporating automated perfusion analysisDanielleByrne, John P.Walsh, Peter J.MacMahon2019 | Emergency Radiology, Vol. 26, No. 3Comparison of Delay-Sensitive and Delay-Insensitive Computed Tomography Perfusion Methods in Acute Ischemic Stroke and Their Variability According to Location of Critical Vascular StenosisBanuKaraalioglu, AyseAralasmak, HuseyinToprak, MehmetKolukisa, OmerUysal, SeymaYildiz, HuseyinOzdemir, AlpayAlkan2018 | Journal of Computer Assisted Tomography, Vol. 42, No. 1Mechanical Thrombectomy in Wake-Up Strokes: A Case Series Using Alberta Stroke Program Early CT Score (ASPECTS) for Patient SelectionAngelos AristeidisKonstas, ArtinMinaeian, Ian B.Ross2017 | Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 7Selection Paradigms for Large Vessel Occlusion Acute Ischemic Stroke Endovascular TherapyMehdiBouslama, Meredith T.Bowen, Diogo C.Haussen, SeenaDehkharghani, Jonathan A.Grossberg, Letícia C.Rebello, SrikantRangaraju, Michael R.Frankel, Raul G.Nogueira2017 | Cerebrovascular Diseases, Vol. 44, No. 5-6Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic StrokeMichal M.Kawiorski, AgustinaVicente, DanielLourido, AlfonsoMuriel, EduardoFandiño, José C.Méndez, VíctorSánchez-González, AlbaAguado, RodrigoÁlvarez-Velasco, MaríaAlonso de Leciñana2016 | Journal of Stroke and Cerebrovascular Diseases, Vol. 25, No. 5CT perfusion in acute stroke calls: A pictorial review and differential diagnosesAlbert HChiu, Timothy JPhillips, Constantine CPhatouros, Tejinder PSingh, Graeme JHankey, David JBlacker, WilliamMcAuliffe2016 | Journal of Medical Imaging and Radiation Oncology, Vol. 60, No. 2Acute Multi-modal Neuroimaging in a Porcine Model of Endothelin-1-Induced Cerebral Ischemia: Defining the Acute Infarct CoreChristopher D.d’Esterre, Richard IAviv, LauraMorrison, EnricoFainardi, Ting YimLee2015 | Translational Stroke Research, Vol. 6, No. 3Large-Vessel Occlusion Stroke: Effect of Recanalization on Outcome Depends on the National Institutes of Health Stroke Scale ScoreKarolinaSkagen, MonaSkjelland, DavidRussell, Eva A.Jacobsen2015 | Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 7Evaluación vascular en el código ictus: papel de la angio-tomografía computarizadaM.Mendigaña Ramos, T.Cabada Giadas2015 | Radiología, Vol. 57, No. 2Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic StrokeChristopher D.d’Esterre, Mari E.Boesen, Seong HwanAhn, PoonehPordeli, MohamedNajm, PriyankaMinhas, PanizDavari, EnricoFainardi, MartaRubiera, Alexander V.Khaw, AndreaZini, RichardFrayne, Michael D.Hill, Andrew M.Demchuk, Tolulope T.Sajobi, Nils D.Forkert, MayankGoyal, Ting Y.Lee, Bijoy K.Menon2015 | Stroke, Vol. 46, No. 12Effect of Extended CT Perfusion Acquisition Time on Ischemic Core and Penumbra Volume Estimation in Patients with Acute Ischemic Stroke due to a Large Vessel OcclusionJordiBorst, Henk A.Marquering, Ludo F. M.Beenen, Olvert A.Berkhemer, Jan WillemDankbaar, Alan J.Riordan, Charles B. L. M.Majoie2015 | PLOS ONE, Vol. 10, No. 3Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic StrokeRalph R. E. G.Geuskens, JordiBorst, MaritLucas, A. M. MerelBoers, Olvert A.Berkhemer, Yvo B. W. E. M.Roos, Marianne A. A.van Walderveen, Sjoerd F. M.Jenniskens, Wim H.van Zwam, Diederik W. J.Dippel, Charles B. L. M.Majoie, Henk A.Marquering, JohannesBoltze2015 | PLOS ONE, Vol. 10, No. 11CT perfusion in acute stroke: Know the mimics, potential pitfalls, artifacts, and technical errorsRajivMangla, SvenEkhom, Babak S.Jahromi, JeevakAlmast, ManishaMangla, Per-LennartWestesson2014 | Emergency Radiology, Vol. 21, No. 1Ischemic Stroke in Evolution: Predictive Value of Perfusion Computed TomographyAmirKheradmand, MarcFisher, DavidPaydarfar2014 | Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 5Reliability of CT Perfusion in the Evaluation of the Ischaemic PenumbraJosé EduardoAlves, ÂngeloCarneiro, JoãoXavier2014 | The Neuroradiology Journal, Vol. 27, No. 1Perfusion Imaging in Acute Ischemic Stroke: Let Us Improve the Science before Changing Clinical PracticeMayank Goyal, , Bijoy K. Menon, , and Colin P. Derdeyn, 1 January 2013 | Radiology, Vol. 266, No. 1Accuracy of CT cerebral perfusion in predicting infarct in the emergency department: lesion characterization on CT perfusion based on commercially available softwareChang Y.Ho, SajjadHussain, TariqAlam, IftikharAhmad, Isaac C.Wu, Darren P.O’Neill2013 | Emergency Radiology, Vol. 20, No. 3A Fast Nonlinear Regression Method for Estimating Permeability in CT Perfusion ImagingEdwinBennink, Alan JRiordan, Alexander DHorsch, Jan WillemDankbaar, Birgitta KVelthuis, Hugo Wde Jong2013 | Journal of Cerebral Blood Flow & Metabolism, Vol. 33, No. 11Persistent Benign Oligemia Causes CT Perfusion Mismatch in Patients with Intracranial Large Artery Occlusive Disease during Subacute StrokeJing-JingLi, Xiang-YanChen, YannieSoo, Jill M.Abrigo, Thomas W.Leung, EdwardWong, VincentMok, James S.W.Cheung, Anil T.Ahuja, Jin-ShengZeng, Ka-SingWong2013 | CNS Neuroscience & Therapeutics, Vol. 19, No. 8Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous ThrombolysisN.Sillanpää, J.T.Saarinen, H.Rusanen, I.Elovaara, P.Dastidar, S.Soimakallio2013 | American Journal of Neuroradiology, Vol. 34, No. 1Recognizing False Ischemic Penumbras in CT Brain Perfusion StudiesAlan C. Best, , Natasha R. Acosta, , Jennifer E. Fraser, , Manuel T. Borges, , Kerry E. Brega, , Tracey Anderson, , Robert T. Neumann, , Alexander Ree, , and Robert J. Bert, 27 June 2012 | RadioGraphics, Vol. 32, No. 4The alphabet soup of perfusion CT and MR imaging: terminology revisited and clarified in five questionsCarlosLeiva-Salinas, James M.Provenzale, KohsukeKudo, MakotoSasaki, MaxWintermark2012 | Neuroradiology, Vol. 54, No. 9Perfusion linearity and its applications in perfusion algorithm analysisOleg S.Pianykh2012 | Computerized Medical Imaging and Graphics, Vol. 36, No. 3Digital Perfusion Phantoms for Visual Perfusion ValidationOleg S.Pianykh2012 | American Journal of Roentgenology, Vol. 199, No. 3CT Perfusion Mean Transit Time Maps Optimally Distinguish Benign Oligemia from True “At-Risk” Ischemic Penumbra, but Thresholds Vary by Postprocessing TechniqueShervinKamalian, ShahmirKamalian, A.A.Konstas, M.B.Maas, S.Payabvash, S.R.Pomerantz, P.W.Schaefer, K.L.Furie, R.G.González, M.H.Lev2012 | American Journal of Neuroradiology, Vol. 33, No. 3Clinical Stroke Penumbra: Use of National Institutes of Health Stroke Scale as a Surrogate for CT Perfusion in Patient Triage for Intra-Arterial Middle Cerebral Artery Stroke TherapyJ.L.Boxerman, M.V.Jayaraman, W.A.Mehan, J.M.Rogg, R.A.Haas2012 | American Journal of Neuroradiology, Vol. 33, No. 10Differences in CT Perfusion Summary Maps for Patients with Acute Ischemic Stroke Generated by 2 Software PackagesF.Fahmi, H.A.Marquering, G.J.Streekstra, L.F.M.Beenen, B.K.Velthuis, E.VanBavel, C.B.Majoie2012 | American Journal of Neuroradiology, Vol. 33, No. 11Dramatically Reducing Imaging-to-Recanalization Time in Acute Ischemic Stroke: Making ChoicesM.Goyal, M.A.Almekhlafi2012 | American Journal of Neuroradiology, Vol. 33, No. 7Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: Definitions and thresholdsKrishna A.Dani, Ralph G.R.Thomas, Francesca M.Chappell, KirstenShuler, Mary J.MacLeod, Keith W.Muir, Joanna M.Wardlaw2011 | Annals of Neurology, Vol. 70, No. 3Acute Ischemic StrokeAngelos A.Konstas, R. GilbertoGonzález, Michael H.Lev2011CT Perfusion Imaging in Acute StrokeAngelos A.Konstas, MaxWintermark, Michael H.Lev2011 | Neuroimaging Clinics of North America, Vol. 21, No. 2CT Cerebral Blood Flow Maps Optimally Correlate With Admission Diffusion-Weighted Imaging in Acute Stroke but Thresholds Vary by Postprocessing PlatformShahmirKamalian, ShervinKamalian, Matthew B.Maas, Greg V.Goldmacher, SeyedmehdiPayabvash, AdnanAkbar, Pamela W.Schaefer, Karen L.Furie, R. GilbertoGonzalez, Michael H.Lev2011 | Stroke, Vol. 42, No. 7Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 HoursLaszlo K.Sztriha, DulkaManawadu, JozefJarosz, JeffKeep, LalitKalra, OlivierBaud2011 | PLoS ONE, Vol. 6, No. 10Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive reviewAlbert JYoo, BenjaminPulli, R GilbertoGonzalez2011 | Expert Review of Cardiovascular Therapy, Vol. 9, No. 7Differences in CT Perfusion Maps Generated by Different Commercial Software: Quantitative Analysis by Using Identical Source Data of Acute Stroke PatientsA.M.McKinney2010Jan1 | Yearbook of Neurology and Neurosurgery, Vol. 2010Perfusion CT in Acute Ischemic Stroke: A Qualitative and Quantitative Comparison of Deconvolution and Maximum Slope ApproachB.Abels, E.Klotz, B.F.Tomandl, S.P.Kloska, M.M.Lell2010 | American Journal of Neuroradiology, Vol. 31, No. 9Recommended Articles Whole-Brain CT Perfusion to Quantify Acute Ischemic Penumbra and CoreRadiology2016Volume: 279Issue: 3pp. 876-887Imaging-based Selection for Endovascular Treatment in StrokeRadioGraphics2019Volume: 39Issue: 6pp. 1696-1713Attenuation Changes in ASPECTS Regions: A Surrogate for CT Perfusion–based Ischemic Core in Acute Ischemic StrokeRadiology2019Volume: 291Issue: 2pp. 451-458Acute Stroke: Prognostic Value of Quantitative Collateral Assessment at Perfusion CTRadiology2019Volume: 290Issue: 3pp. 760-768CT for Treatment Selection in Acute Ischemic Stroke: A Code Stroke PrimerRadioGraphics2019Volume: 39Issue: 6pp. 1717-1738See More RSNA Education Exhibits Acute Ischemic Stroke: Time is Life — An Approach for No MistakesDigital Posters2019“Stroke Alert!” ER Dilemma, What is Next? CT Perfusion (CTP) or Fast Brain MRIDigital Posters2022Interpretation of CT Perfusion in Acute Ischemic Stroke: A Practical GuideDigital Posters2019 RSNA Case Collection Acute ischemic strokeRSNA Case Collection2020Post-carotid-endarterectomy cerebral hyperperfusion syndromeRSNA Case Collection2021Ischemic stroke in moyamoya diseaseRSNA Case Collection2020 Vol. 254, No. 1 Metrics Altmetric Score PDF download" @default.
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