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• ROC curve : determine the cutoff value , sensitivity , specificity of FEP for predict HT.. Summary[r]
(1)1
The diagnostic value of CT perfusion The diagnostic value of CT perfusion
for prediction hemorrhagic
transformation in acute ischemic stroke patients
stroke patients Radiology Center - Bạch Mai Hospital
Nguyễn Cơng Tiến, Nguyễn Quang Anh, Lê Hồng Kiên, Nguyễn Tất Thiện, Lê Chí Cơng Nguyễn Thu Hương , Vũ Đăng Lưu
Backgroup
•Stroke is one of leading killer in the world
•Mechanical thrombectomy (MT) is now
d d t t t f t i h i t k
recommended treatment for acute ischemic stroke
(AIS)
•Hemorrhagic transformation (HT) is most serius
complication in AIS patients
• Perfusion CT (PCT) usually perform in AIS patients to
select patients under go MT
•Flow extraction production (FEP) derived PCT
(2)Purpose
To investigate whether FEP can
predict hemorrhagic transformation
in AIS patients treated mechanical
thrombectomy ?
Materials and Methods
Inclusion criteria
• Clinical signs suspected stroke • CT to confirm no hemorrhage • CT to confirm no hemorrhage
• CTA, CTP confirm large cerebral artery occlusion • Under go mechanical thrombectomy
• Following by CT or CHT at 18 - 24 hours after MT
Data analysisy
• Student t-test: to compare the clinical, PCT parameters between two groups (HT, no HT)
(3)3
CTA, CTP protocol
•MSCT Definition Edge, Siemens
•CT non-contrast: 0.6 mm, 120 KV, 200 mAs
•CT angiography (CTA): 0.6 mm, 120 KV, 160 mAs
•CT perfusion (PCT): 0.6 mm, 100 KV, 80 mAs
(2 phase: total 120 seconds) First phase: p 1.5s / cycle x y 30 times
Delay phase: 15s / cycle x 1 time + 30s / cycle x 2 times
• Total radiation dose: 6.2 mSv
• Perfusion stroke software, syngo via, Siemens
Patient characteristics
(n = 47) No HT
(n = 23)
HT (n = 24)
p-value
Age (years) 63 ± 14 66 ± 13 0.3 Male (%) 27/20 (57.4%)
(4)PRR, Infarction between two groups L) ns ns PRR (%) farction (m L HT
No HT No HT HT
In
f
Penumbra, FEP between two groups
0g)
L)
p = 0.08 p < 0.01
(5)5
Predict value of FEP for HT
1.41
Cutoff: 1.41 AUC: 0.83
Specificity: 96% Sensitivity: 67% Sensitivity Sensitivity: 67%
Specificity
Multivariate logistic regression analysis
Univariate Multivariate Odds
ratio
95% CI p-value Odds ratio
95% CI p-value
ratio ratio
NIHSS 1.09 0.9 – 1.31 0.4 ASPECTS 0.89 0.37 – 2.13 0.8
Onset-reperfusion (min)
1 0.996 - 0.9
Penumbra (mL) 0.98 0.96 - 1 0.1 0.98 0.96 - 1 0.08
Infarction (mL) 0.99 0.96 – 1.02 0.5
PRR (%) 0.99 0.96 - 1.03 0.8
FEP(mg/mL/100g) 7.01 1.6 – 30.8 0.009 9.21 1.7 - 50 0.01
Univariate: HT ~ NIHSS, ASPECTS, onset to reperfusion, penumbra, infarction, PRR, FEP
(6)Summary
•NIHSS, ASPECTS, Penumbra, PRR, Ageg , , genderg were not difference
between two groups
•FEP and Penumbra in HT were
significant higher than those in no HT
•With cutoff value of 1,41 (mg/ml/min) FEP
has sensitivity of 67 %, specificity of 96% for predict HT
Conclusions
•HT after MT therapy may be predicted by
pretreatment CTP-FEP
p
•FEP may help physicians to select AIS patients for revascularization therapy to
(7)7
Female 74y, onset 7h, suddenly weakness
1.8 0.3
MIP
CBF CBV FEP T2*-24h
PRR: 85%
Male 54y, suddenly weakness, onset 10h
CBF CBV FEP T2*-24h
1.80.9 0.3
MIP
CBF CBV FEP T2 -24h
PRR: 92%
(8)0.91 1.49
MIP
Flow extraction production
(FEP) T2*-24h
Male 33y, NIHSS 12, PRR 96%, FEP 1.03
0 61 03
MIP Flow extraction
production (FEP) T2*-24h
(9)9 Thank you so much !
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