Identifying perfusion deficits on CT perfusion images using temporal similarity perfusion (TSP) mapping
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Deconvolution-derived maps of CT perfusion (CTP) data may be confounded by transit delays. We propose temporal similarity perfusion (TSP) analysis to decrease CTP maps’ dependence on transit times and investigate its sensitivity to detect perfusion deficits.
CTP data of acute stroke patients obtained within 9 h of symptom onset was analyzed using a delay-insensitive singular value decomposition method and with TSP. The TSP method applies an iterative process whereby a pixel’s highest Pearson’s R value is obtained through comparison of a pixel’s time-shifted signal density time-series curve and the average whole brain signal density time-series curve. Our evaluation included a qualitative and quantitative rating of deconvolution maps (MTT, CBV, and TTP), of TSP maps, and of follow-up CT.
Sixty-five patients (mean 68 (SD 13) years, 34 male) were included. A perfusion deficit was identified in 90%, 86%, 65%, and 84% of MTT, TTP, CBV, and TSP maps. The agreement of MTT, TTP, and TSP with CT follow-up was comparable but noticeably lower for CBV. CBV had the best relationship with final infarct volume (R2 = 0.77, p < 0.001), followed by TSP (R2 = 0.63, p < 0.001). Intra-rater agreement of an inexperienced reader was higher for TSP than for CBV/MTT maps (kappa’s of 0.79–0.84 and 0.63–0.7). Inter-rater agreement for experienced readers was comparable across maps.
TSP maps are easier to interpret for inexperienced readers. Perfusion deficits detected by TSP are smaller which may suggest less dependence on transit delays although more investigation is required.
• Temporal similarity perfusion mapping assesses CTP data based on similarities in signal time-curves.
• TSP maps are comparable in perfusion deficit detection to deconvolution maps.
• TSP maps are easier to interpret for inexperienced readers.
KeywordsHumans Stroke Brain ischemia Perfusion Tomography, X-ray computed
Anterior cerebral artery
Alberta stroke program early CT score
Cerebral blood flow
Cerebral blood volume
DUtch acute STroke study
Internal carotid artery
Intravenous recombinant tissue plasminogen activator
Middle cerebral artery
Mean transit time
National Institutes of Health Stroke Scale
Posterior cerebral artery
Positron emission tomography
Temporal similarity perfusion
This study has received funding by the Netherlands Heart Foundation (grant numbers 2008T034, 2012T061, and 2013T047) and the Nuts Ohra Foundation (grant number 0903–012).
Compliance with ethical standards
The scientific guarantor of this publication is Reinoud P.H. Bokkers.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in studies related to the Dutch acute STroke study (http://www.clinicaltrials.gov. Unique identifier: NCT00880113).
• cross-sectional study
• multicenter study
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