RT Journal Article
SR Electronic
T1 ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 2104
OP 2110
DO 10.1212/WNL.0b013e3181aa5329
VO 72
IS 24
A1 Sims, J. R.
A1 Gharai, L. Rezai
A1 Schaefer, P. W.
A1 Vangel, M.
A1 Rosenthal, E. S.
A1 Lev, M. H.
A1 Schwamm, L. H.
YR 2009
UL http://n.neurology.org/content/72/24/2104.abstract
AB Background: Rapid and easy clinical assessments for volumes of infarction and perfusion mismatch are needed. We tested whether simple geometric models generated accurate estimates of these volumes. Methods: Acute diffusion-weighted image (DWI) and perfusion (mean transit time [MTT]) in 63 strokes and established infarct volumes in 50 subacute strokes were measured by computerized planimetry. Mismatch was defined as MTT/DWI ≥ 1.2. Observers, blinded to planimetric values, measured lesions in three perpendicular axes A, B, and C. Geometric estimates of sphere, ellipsoid, bicone, and cylinder were compared to planimetric volume by least-squares linear regression. Results: The ABC/2 formula (ellipsoid) was superior to other geometries for estimating volume of DWI (slope 1.16, 95% confidence interval [CI] 0.94 to 1.38; R2 = 0.91, p = 0.001) and MTT (slope 1.11, 95% CI 0.99 to 1.23; R2 = 0.89, p = 0.001). The intrarater and interrater reliability for ABC/2 was high for both DWI (0.992 and 0.965) and MTT (0.881 and 0.712). For subacute infarct, the ABC/2 formula also best estimated planimetric volume (slope 1.00, 95% CI 0.98 to 1.19; R2 = 0.74, p = 0.001). In general, sphere and cylinder geometries overestimated all volumes and bicone underestimated all volumes. The positive predictive value for mismatch was 92% and negative predictive value was 33%. Conclusions: Of the models tested, ABC/2 is reproducible, is accurate, and provides the best simple geometric estimate of infarction and mean transit time volumes. ABC/2 has a high positive predictive value for identifying mismatch greater than 20% and might be a useful tool for rapid determination of acute stroke treatment. CBF=cerebral blood flow; CBV=cerebral blood volume; CI=confidence interval; DWI=diffusion-weighted image; FOV=field of view; ICH=intracerebral hemorrhage; MCA=middle cerebral artery; MTT=mean transit time; PWI=perfusion-weighted imaging; ROI=region of interest; TE=echo time; TR=repetition time.