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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01130

Dynamic CT but not multiphase CT angiography accurately identifies CT perfusion target mismatch ischemic stroke patients

 Huiqiao Tian1*,  Chushuang Chen1,  Carlos Garcia-Esperon1, Mark W. Parsons2, Longting Lin1,  Christopher Levi1 and Andrew Bivard2
  • 1Department of Neurology, John Hunter Hospital, Australia
  • 2Department of Neurology, Royal Melbourne Hospital, Australia

Imaging protocols for acute ischemic stroke varies significantly from center to center leading to challenges in research translation. We aimed to assess the inter-rater reliability of collateral grading systems derived from dynamic computed tomography angiography (CTA) and an optimized multiphase CTA. Also, to compare the accuracy of dynamic CTA (dCTA) and optimized multiphase CTA (omCTA) to CT perfusion (CTP) in identifying target mismatch. Acute ischemic stroke patients with a proximal large vessel occlusion underwent whole brain CTP. We assessed the status of collaterals using ASPECTS collateral system (Alberta Stroke Program Early CT Score on Collaterals) and ASITN/SIR collateral system (the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on dCTA and omCTA, and compared the interrater reliability using Krippendorff’s alpha and Cohen’s kappa. Eighty-one patients were included, with a median ischemic core volume of 29 mL. The collateral assessment with ASPECTS collaterals using dCTA have a similar inter-rater agreement (K-alpha: 0.71) compared to omCTA (K-alpha: 0.69). However, the agreement between dCTA and CTP in classifying patients with target mismatch was higher compared to omCTA (Kappa, dCTA: 0.81; omCTA: 0.64). We found dCTA was more accurate than omCTA in identifying target mismatch patients with proximal large vessel occlusion.

Keywords: Acute ischemic stroke1, CT perfusion2, dynamic CTA3, multiphase CTA4, collaterals5

Received: 23 Aug 2019; Accepted: 09 Oct 2019.

Copyright: © 2019 Tian, Chen, Garcia-Esperon, Parsons, Lin, Levi and Bivard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Huiqiao Tian, Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia,