Impact of Intracranial Volume and Brain Volume on the Prognostic Value of Computed Tomography Perfusion Core Volume in Acute Ischemic Stroke

Jan W Hoving; Praneeta R Konduri; Manon L Tolhuisen; Miou S Koopman; Henk van Voorst; Laura M Van Poppel; Jasper D Daems; Adriaan C G M van Es; Marianne A A van Walderveen; Hester F Lingsma; Diederik W J Dippel; Wim H Van Zwam; Henk A Marquering; Charles B L M Majoie; Bart J Emmer; MR CLEAN Registry Investigators

doi:10.3390/jcdd11030080

Impact of Intracranial Volume and Brain Volume on the Prognostic Value of Computed Tomography Perfusion Core Volume in Acute Ischemic Stroke

J Cardiovasc Dev Dis. 2024 Feb 28;11(3):80. doi: 10.3390/jcdd11030080.

Authors

Jan W Hoving¹, Praneeta R Konduri^{1

2}, Manon L Tolhuisen^{1

2}, Miou S Koopman¹, Henk van Voorst^{1

2}, Laura M Van Poppel^{1

2}, Jasper D Daems^{3

4}, Adriaan C G M van Es⁵, Marianne A A van Walderveen⁵, Hester F Lingsma⁴, Diederik W J Dippel⁴, Wim H Van Zwam⁶, Henk A Marquering^{1

2}, Charles B L M Majoie¹, Bart J Emmer¹; MR CLEAN Registry Investigators

Affiliations

¹ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
² Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
³ Department of Public Health, Erasmus University Medical Center, P.O. Box 2040 Rotterdam, The Netherlands.
⁴ Department of Neurology, Erasmus University Medical Center, P.O. Box 2040 Rotterdam, The Netherlands.
⁵ Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
⁶ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6202 AZ Maastricht, The Netherlands.

Abstract

Background: Computed tomography perfusion (CTP)-estimated core volume is associated with functional outcomes in acute ischemic stroke. This relationship might differ among patients, depending on brain volume.

Materials and methods: We retrospectively included patients from the MR CLEAN Registry. Cerebrospinal fluid (CSF) and intracranial volume (ICV) were automatically segmented on NCCT. We defined the proportion of the ICV and total brain volume (TBV) affected by the ischemic core as ICV_core and TBV_core. Associations between the core volume, ICV_core, TBV_core, and functional outcome are reported per interquartile range (IQR). We calculated the area under the curve (AUC) to assess diagnostic accuracy.

Results: In 200 patients, the median core volume was 13 (5-41) mL. Median ICV and TBV were 1377 (1283-1456) mL and 1108 (1020-1197) mL. Median ICV_core and TBV_core were 0.9 (0.4-2.8)% and 1.7 (0.5-3.6)%. Core volume (acOR per IQR 0.48 [95%CI 0.33-0.69]), ICV_core (acOR per IQR 0.50 [95%CI 0.35-0.69]), and TBV_core (acOR per IQR 0.41 95%CI 0.33-0.67]) showed a lower likelihood of achieving improved functional outcomes after 90 days. The AUC was 0.80 for the prediction of functional independence at 90 days for the CTP-estimated core volume, the ICV_core, and the TBV_core.

Conclusion: Correcting the CTP-estimated core volume for the intracranial or total brain volume did not improve the association with functional outcomes in patients who underwent EVT.

Keywords: CT perfusion; stroke; thrombectomy.

Grants and funding

The MR CLEAN Registry was funded and carried out by the Erasmus University Medical Center, the Academic Medical Center Amsterdam, and the Maastricht University Medical Center. The Registry was additionally funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie). J.W.H. was funded by Leading the Change (LtC) (grant number 80-85009-98-2015). LtC is financed by Zorgverzekeraars Nederland and supports various healthcare evaluations in The Netherlands as part of the Healthcare Evaluation Netherlands. PK was funded by INSIST (www.insist-h2020.eu, accessed 31 January 2024), a European Union’s Horizon 2020 research and innovation programme (grant agreement number: 777072), and the RadPath AI project.