Evaluation of time-resolved whole brain flat panel detector perfusion imaging using RAPID ANGIO in patients with acute stroke: comparison with CT perfusion imaging

Abstract

Background: In contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite.

Objective: To evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software.

Methods: We included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging.

Results: A total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) <30% and FD-CTP rCBF <45% showed good correlation (R2=0.84). Comparisons of conventional CTP Tmax >6 s versus FD-CTP Tmax >6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%).

Conclusions: In our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.

Keywords: CT perfusion; Stroke; Thrombectomy.

Conflict of interest statement

Competing interests: PM reports receipt of research support from Siemens, Cerenovus, Medtronic, Stryker, the Swiss Heart Foundation. and the Swiss National Foundation; receipt of consultant fees from Medtronic, Cerenovus, Phenox, and Microvention, unrelated to the submitted work. DLC reports funding by a Siemens Healthineers-Grant. MP reports research collaboration with Siemens. DKL is a member of the advisory board of Siemens and honoraria/consultant for RAPID. AI, Stryker, Medtronic, Siemens, Phenox, Asahi. He reports stock options of Three Rivers, QAPEL, Methinks, Bendit, Synchron, Vastrax, NTI, VizAI, ELUM. GWA is a consultant for Gentech and is a consultant for, and has equity interests in, iSchemaView. JK reports grants from the Swiss Academy of Medical Sciences/Bangerter Foundation, Swiss Stroke Society, and Clinical Trials Unit Bern during the conduct of the study.

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