Comparison of multimodal CT scan protocols used for decision-making on mechanical thrombectomy in acute ischemic stroke

被引：16

作者：

Khumtong, Rujimas ^{[1
,2
]}

Krings, Timo ^{[1
]}

Pereira, Vitor M. ^{[1
]}

Pikula, Aleksandra ^{[3
]}

Schaafsma, Joanna D. ^{[3
]}

机构：

[1] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Div Neuroradiol,Dept Med Imaging, Toronto, ON, Canada

[2] Prince Songkla Univ, Songklanagarind Hosp, Dept Radiol, Div Diagnost Radiol, Songkhla, Thailand

[3] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Div Neurol,Dept Med, 5WW-425,399 Bathurst St, Toronto, ON M5T 2S8, Canada

来源：

NEURORADIOLOGY | 2020年 / 62卷 / 03期

关键词：

Stroke; Thrombectomy; Computed tomography angiography; CT perfusion; Decision-making; FINAL INFARCT VOLUME; ENDOVASCULAR THERAPY; DIAGNOSTIC-ACCURACY; NONCONTRAST CT; PERFUSION; ANGIOGRAPHY; SELECTION; PREDICT; GUIDELINES; MANAGEMENT;

D O I：

10.1007/s00234-019-02351-5

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Purpose Different CT-based protocols are being used in acute ischemic stroke. We aimed to assess the added value of delayed-phase CT angiography (CTA) and CT perfusion (CTP) to a basic protocol using non-contrast computerized tomography (NCCT) with arterial-phase CTA in patient selection for mechanical thrombectomy. Methods We retrospectively included consecutive acute ischemic stroke patients with a symptomatic intracranial arterial occlusion between January 2015 and November 2016 who underwent NCCT, arterial and delayed-phase CTA, and CTP. These imaging studies were grouped into five protocols: (1) NCCT and arterial-phase CTA; (2) NCCT, arterial-phase CTA, and CTP; (3) NCCT, arterial- and delayed-phase CTA; (4) NCCT, arterial- and delayed-phase CTA, and CTP; and (5) NCCT and delayed-phase CTA. Two interventional neuro-radiologists independently decided on mechanical thrombectomy for each patient based on the protocols. They reached consensus for discrepant decisions. We assessed the raters' confidence level, inter-rater agreement, and compared treatment decisions for the different protocols. Results We included 73 patients (44% male, mean age 74). The inter-rater agreement was substantial for protocols with three or more modalities ( = 0.613-0.704) and moderate for two-modality protocols ( = 0.506-0.529). The highest agreement and confidence level was achieved for the combination of NCCT, arterial-phase CTA, and CTP. Adding CTP to NCCT and arterial-phase CTA resulted in a 10% increase of recommendations for mechanical thrombectomy and adding delayed-phase CTA resulted in a 4% increase. These management changes did not reach statistical significance (p = 0.07; p = 0.25, respectively). Conclusion Adding CTP and/or a delayed-phase CTA to NCCT with arterial-phase CTA improves the decision-maker's confidence level and creates a trend towards a lower threshold for mechanical thrombectomy.

引用

页码：399 / 406

页数：8

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