Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study

On behalf of the INTERRSeCT Investigators

doi:10.1007/s00234-019-02320-y

Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study

On behalf of the INTERRSeCT Investigators

Neurology

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. Methods: Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). Results: Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HU_max ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2–64.6) when HU_max > 89 vs. 16.8% (95%CI 13.0–20.6) when HU_max ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1–4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). Conclusion: Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.

Original language	English (US)
Pages (from-to)	301-306
Number of pages	6
Journal	Neuroradiology
Volume	62
Issue number	3
DOIs	https://doi.org/10.1007/s00234-019-02320-y
State	Published - Mar 1 2020

Keywords

Acute ischemic stroke
CTA
NCCT
Recanalization therapies
Thrombus permeability

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Clinical Neurology
Cardiology and Cardiovascular Medicine

Access to Document

10.1007/s00234-019-02320-y

Fingerprint Dive into the research topics of 'Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study'. Together they form a unique fingerprint.

Cite this

@article{1edd14d9ab154f66ada5c850c0ce4d3c,

title = "Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study",

abstract = "Purpose: To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. Methods: Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). Results: Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2–64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0–20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1–4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). Conclusion: Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.",

keywords = "Acute ischemic stroke, CTA, NCCT, Recanalization therapies, Thrombus permeability",

author = "{On behalf of the INTERRSeCT Investigators} and Henrik Gensicke and Evans, {James W.} and {Al Ajlan}, {Fahad S.} and Dar Dowlatshahi and Mohamed Najm and Calleja, {Ana L.} and Josep Puig and Sohn, {Sung l.I.} and Ahn, {Seong H.} and Poppe, {Alexandre Y.} and Robert Mikulik and Negar Asdaghi and Field, {Thalia S.} and Albert Jin and Talip Asil and Boulanger, {Jean Martin} and Hill, {Michael D.} and Mayank Goyal and Demchuk, {Andrew M.} and Menon, {Bijoy K.}",

note = "Funding Information: This study was supported by an operating grant from the Canadian Institutes of Health Research and by a grant from the Swiss National Foundation (P300PB_161071). Funding Information: Henrik Gensicke has received research support from the Swiss National Science Foundation. James W Evans, Fahad S. Al Ajlan, Dar Dowlatshah, Mohamed Najm, Ana L. Calleja, Josep Puid, Sung-lI Sohn, Seong H. Ahn, Alexandre Y Poppe, Negar Asdaghi, Albert Jin, Talip Asil, and Jean-Martin Boulanger declare that they have no conflict of interest. Robert Mikulik has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). Thalia S. Field has received research support from the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, the Heart and Stroke Foundation of Canada, the Vancouver Coastal Health Research Institute, and Bayer Canada (study medication). Michael D. Hill is supported by the Heart & Stroke Foundation of Alberta-Hotchkiss Brain Institute Professorship in Stroke Research. Mayank Goyal has received consulting fees from Medtronic, Stryker, and Microvention and holds a patent on a system of acute stroke diagnosis licensed to GE Healthcare. Andrew M. Demchuk has received honoraria from Medtronic for CME events. He also received operational grant funding from the Canadian Institute for Health Research for the INTERRSeCT study. Bijoy K. Menon holds the Heart and Stroke Foundation Professorship in Stroke Imaging and has received operational grant funding from the Canadian Institute of Health Research. ",

year = "2020",

month = mar,

day = "1",

doi = "10.1007/s00234-019-02320-y",

language = "English (US)",

volume = "62",

pages = "301--306",

journal = "Neuroradiology",

issn = "0028-3940",

publisher = "Springer Verlag",

number = "3",

}

TY - JOUR

T1 - Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study

AU - On behalf of the INTERRSeCT Investigators

AU - Gensicke, Henrik

AU - Evans, James W.

AU - Al Ajlan, Fahad S.

AU - Dowlatshahi, Dar

AU - Najm, Mohamed

AU - Calleja, Ana L.

AU - Puig, Josep

AU - Sohn, Sung l.I.

AU - Ahn, Seong H.

AU - Poppe, Alexandre Y.

AU - Mikulik, Robert

AU - Asdaghi, Negar

AU - Field, Thalia S.

AU - Jin, Albert

AU - Asil, Talip

AU - Boulanger, Jean Martin

AU - Hill, Michael D.

AU - Goyal, Mayank

AU - Demchuk, Andrew M.

AU - Menon, Bijoy K.

N1 - Funding Information: This study was supported by an operating grant from the Canadian Institutes of Health Research and by a grant from the Swiss National Foundation (P300PB_161071). Funding Information: Henrik Gensicke has received research support from the Swiss National Science Foundation. James W Evans, Fahad S. Al Ajlan, Dar Dowlatshah, Mohamed Najm, Ana L. Calleja, Josep Puid, Sung-lI Sohn, Seong H. Ahn, Alexandre Y Poppe, Negar Asdaghi, Albert Jin, Talip Asil, and Jean-Martin Boulanger declare that they have no conflict of interest. Robert Mikulik has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). Thalia S. Field has received research support from the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, the Heart and Stroke Foundation of Canada, the Vancouver Coastal Health Research Institute, and Bayer Canada (study medication). Michael D. Hill is supported by the Heart & Stroke Foundation of Alberta-Hotchkiss Brain Institute Professorship in Stroke Research. Mayank Goyal has received consulting fees from Medtronic, Stryker, and Microvention and holds a patent on a system of acute stroke diagnosis licensed to GE Healthcare. Andrew M. Demchuk has received honoraria from Medtronic for CME events. He also received operational grant funding from the Canadian Institute for Health Research for the INTERRSeCT study. Bijoy K. Menon holds the Heart and Stroke Foundation Professorship in Stroke Imaging and has received operational grant funding from the Canadian Institute of Health Research.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Purpose: To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. Methods: Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). Results: Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2–64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0–20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1–4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). Conclusion: Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.

AB - Purpose: To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. Methods: Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). Results: Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2–64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0–20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1–4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). Conclusion: Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.

KW - Acute ischemic stroke

KW - CTA

KW - NCCT

KW - Recanalization therapies

KW - Thrombus permeability

UR - http://www.scopus.com/inward/record.url?scp=85075197282&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075197282&partnerID=8YFLogxK

U2 - 10.1007/s00234-019-02320-y

DO - 10.1007/s00234-019-02320-y

M3 - Article

C2 - 31713667

AN - SCOPUS:85075197282

VL - 62

SP - 301

EP - 306

JO - Neuroradiology

JF - Neuroradiology

SN - 0028-3940

IS - 3

ER -