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

University of Calgary
University of Basel
Central Coast Local Health District
King Faisal Specialist Hospital and Research Centre
University of Ottawa
University of Valladolid
Dr. Josep Trueta University Hospital
Keimyung University
Chosun University
Centre Hospitalier de L'Universite de Montreal
Masaryk University
University of Miami
University of British Columbia
Queen's University Kingston
Bezmialem Vakif Univesitesi Noroloji
University of Sherbrooke

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

3 Scopus citations

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
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 - 1 Mar 2020
Externally published	Yes

Keywords

Acute ischemic stroke
CTA
NCCT
Recanalization therapies
Thrombus permeability

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10.1007/s00234-019-02320-y

Cite this

@article{30ed340e42044b578f394726be744967,

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{\textendash}64.6) when HUmax > 89 vs. 16.8\% (95\%CI 13.0{\textendash}20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1{\textendash}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 = "Publisher Copyright: {\textcopyright} 2019, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2020",

month = mar,

day = "1",

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

language = "Ingl{\'e}s",

volume = "62",

pages = "301--306",

journal = "Neuroradiology",

issn = "0028-3940",

publisher = "Springer Science and Business Media Deutschland GmbH",

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.

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 - https://www.scopus.com/pages/publications/85075197282

U2 - 10.1007/s00234-019-02320-y

DO - 10.1007/s00234-019-02320-y

M3 - Artículo

C2 - 31713667

AN - SCOPUS:85075197282

SN - 0028-3940

VL - 62

SP - 301

EP - 306

JO - Neuroradiology

JF - Neuroradiology

IS - 3

ER -

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

Abstract

Keywords

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