Abstract
ObjectivesTo report the variation in computed tomography perfusion (CTP) arterial input function (AIF) in a multicenter stroke study and to assess the impact this has on CTP results.MethodsCTP datasets from 14 different centers were included from the DUtch acute STroke (DUST) study. The AIF was taken as a direct measure to characterize contrast bolus injection. Statistical analysis was applied to evaluate differences in amplitude, area under the curve (AUC), bolus arrival time (BAT), and time to peak (TTP). To assess the clinical relevance of differences in AIF, CTP acquisitions were simulated with a realistic anthropomorphic digital phantom. Perfusion parameters were extracted by CTP analysis using commercial software (IntelliSpace Portal (ISP), version 10.1) as well as an in-house method based on block-circulant singular value decomposition (bSVD).ResultsA total of 1422 CTP datasets were included, ranging from 6 to 322 included patients per center. The measured values of the parameters used to characterize the AIF differed significantly with approximate interquartile ranges of 200–750 HU for the amplitude, 2500–10,000 HU·s for the AUC, 0–17 s for the BAT, and 10–26 s for the TTP. Mean infarct volumes of the phantom were significantly different between centers for both methods of perfusion analysis.ConclusionsAlthough guidelines for the acquisition protocol are often provided for centers participating in a multicenter study, contrast medium injection protocols still vary. The resulting volumetric differences in infarct core and penumbra may impact clinical decision making in stroke diagnosis.Key Points• The contrast medium injection protocol may be different between stroke centers participating in a harmonized multicenter study.• The contrast medium injection protocol influences the results of X-ray computed tomography perfusion imaging.• The contrast medium injection protocol can impact stroke diagnosis and patient selection for treatment.
Highlights
The computed tomography perfusion (CTP) protocol is central to a large number of multicenter stroke studies
The contrast medium injection protocol influences the results of X-ray computed tomography perfusion imaging
This paper explores the variation in contrast injection protocol, as characterized by the arterial input function (AIF), for centers participating in a multicenter CTP study to test the hypothesis that substantial differences in CTP results arise
Summary
The computed tomography perfusion (CTP) protocol is central to a large number of multicenter stroke studies. These studies often focus on the impact of endovascular or intraarterial therapies on stroke outcome and use CTP as a selection modality [1,2,3]. The CTP protocol involves a number of technical acquisition and processing steps that may violate this assumption of uniformity [4, 5] This heterogeneity may lead to significantly different (quantitative) results, necessitating harmonization of the acquisition and processing steps. Several aspects of the injection protocol have been deliberated, the clinical variation between centers participating in a harmonized multicenter study and the effect this variation can have on the perfusion analysis have not been studied
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