title: Mean transit time on Aquilion ONE and its utilization in patients undergoing acute stroke intervention.
abstract: BACKGROUND
  Neuroimaging techniques have been beneficial in identifying patients with salvageable penumbra. We sought to validate the mean transit time (MTT) map on computed tomography perfusion (CTP) imaging utilizing an Aquilion ONE computed tomography (CT) scanner running a singular value decomposition plus algorithm in patients with acute large vessel ischemic stroke who underwent endovascular therapy.
  
  
  METHODS
  We conducted a retrospective analysis of consecutive patients presenting to the emergency room who met the following criteria: 1) had a large vessel acute ischemic stroke; 2) had a high-quality whole-brain CTP; 3) treated with endovascular therapy; and 4) received a follow-up MRI with diffusion-weighted imaging (DWI) within 48 h. A blinded neurologist, neuroradiologist, and neurosurgeon utilized the Vitrea software to process the images independently using an infarct perimeter method.
  
  
  RESULTS
  Twelve patients met the inclusion criteria. A comparison was made between the volumes of infarct core (IC) utilizing MTT and DWI after accounting for other co-founding factors (i.e., recanalization rate, time between CT and MRI, time to achieve recanalization, and IV t-PA administration). MTT was redefined as capillary MTT (cMTT) which represented evolving capillary flow influenced by hypoxia induced vasodilation/vasoconstriction. We divided the patients into two groups based on the degree of reperfusion: A) patients with a TICI score of IIb or III and B) patients with a TICI score of I or IIa. We compared the two groups and found that the rate of reperfusion significantly affected the volume of the infarct on MTT when compared with a follow-up MRI (p value < 0.04). Furthermore, we found a strong positive correlation R(2) = 0.6 between the average MTT infarct volume and the final DWI MR volumes. In addition, the averaged MTT IC volumes were 84% of the final averaged DWI IC volumes.
  
  
  CONCLUSIONS
  Although further studies are required to validate this retrospective study, preliminary data suggest that cMTT maps can be a valuable and accurate tool in the assessment of patients with acute stroke who may benefit from aggressive endovascular therapy.
authors.affiliation: JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Haitham
authors.initials: H
authors.lastname: Dababneh
authors.affiliation: JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Asif
authors.initials: A
authors.lastname: Bashir
authors.affiliation: University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Waldo R
authors.initials: WR
authors.lastname: Guerrero
authors.affiliation: Neurosurgery, University of Florida, Gainesville, FL, USA.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Wilson
authors.affiliation: JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Hahnemann University Hospital, Drexel University, Philadelphia, PA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Misthal
authors.affiliation: Neurology, University of Florida, Gainesville, FL, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Morgan
authors.affiliation: Radiology, University of Florida, Gainesville, FL, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Peters
authors.affiliation: JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Jawad F
authors.initials: JF
authors.lastname: Kirmani
authors.affiliation: Neurosurgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
keywords: Acute ischemic stroke; computed tomography perfusion; diffusion-weighted imaging; endovascular intervention; thrombectomy; thromboaspiration; thrombolysis