Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography
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ORIGINAL ARTICLE
Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography Paul Reidler1 · Lena Stueckelschweiger1 · Daniel Puhr-Westerheide1 · Katharina Feil2,3 · Lars Kellert2 · Konstantinos Dimitriadis2,4 · Steffen Tiedt4 · Moriz Herzberg5 · Jan Rémi2 · Thomas Liebig5 · Matthias P. Fabritius1 · Wolfgang G. Kunz1 Received: 7 July 2020 / Accepted: 17 August 2020 © The Author(s) 2020
Abstract Purpose Computed tomography angiography (CTA) is routinely used to detect large-vessel occlusion (LVO) in patients with suspected acute ischemic stroke; however, visual analysis is time consuming and prone to error. To evaluate solutions to support imaging triage, we tested performance of automated analysis of CTA source images (CTASI) at identifying patients with LVO. Methods Stroke patients with LVO were selected from a prospectively acquired cohort. A control group was selected from consecutive patients with clinically suspected stroke without signs of ischemia on CT perfusion (CTP) or infarct on follow-up. Software-based automated segmentation and Hounsfield unit (HU) measurements were performed on CTASI for all regions of the Alberta Stroke Program Early CT score (ASPECTS). We derived different parameters from raw measurements and analyzed their performance to identify patients with LVO using receiver operating characteristic curve analysis. Results The retrospective analysis included 145 patients, 79 patients with LVO stroke and 66 patients without stroke. The parameters hemispheric asymmetry ratio (AR), ratio between highest and lowest regional AR and M2-territory AR produced area under the curve (AUC) values from 0.95–0.97 (all p < 0.001) for detecting presence of LVO in the total population. Resulting sensitivity (sens)/specificity (spec) defined by the Youden index were 0.87/0.97–0.99. Maximum sens/spec defined by the specificity threshold ≥0.70 were 0.91–0.96/0.77–0.83. Performance in a small number of patients with isolated M2 occlusion was lower (AUC: 0.72–0.85). Conclusion Automated attenuation measurements on CTASI identify proximal LVO stroke patients with high sensitivity and specificity. This technique can aid in accurate and timely patient selection for thrombectomy, especially in primary stroke centers without CTP capacity.
Keywords Stroke · Perfusion · Stroke triage · Automated analysis · Thrombectomy
M.P. Fabritius and W.G. Kunz contributed equally.
1
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
Availability of Data and Material The data that supports our findings are made available by the corresponding author upon reasonable request.
2
Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
3
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00062-020-00956-5) contains supplementary material, which is available to authorized users.
German Center for Vertigo and Balance Disorders, LMU Munich, March
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