title: A benchmarking tool to evaluate computer tomography perfusion infarct core predictions against a DWI standard.
abstract: Differences in research methodology have hampered the optimization of Computer Tomography Perfusion (CTP) for identification of the ischemic core. We aim to optimize CTP core identification using a novel benchmarking tool. The benchmarking tool consists of an imaging library and a statistical analysis algorithm to evaluate the performance of CTP. The tool was used to optimize and evaluate an in-house developed CTP-software algorithm. Imaging data of 103 acute stroke patients were included in the benchmarking tool. Median time from stroke onset to CT was 185 min (IQR 180-238), and the median time between completion of CT and start of MRI was 36 min (IQR 25-79). Volumetric accuracy of the CTP-ROIs was optimal at an rCBF threshold of <38%; at this threshold, the mean difference was 0.3 ml (SD 19.8 ml), the mean absolute difference was 14.3 (SD 13.7) ml, and CTP was 67% sensitive and 87% specific for identification of DWI positive tissue voxels. The benchmarking tool can play an important role in optimizing CTP software as it provides investigators with a novel method to directly compare the performance of alternative CTP software packages.
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA Stroke Center, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
authors.forename: Carlo W
authors.initials: CW
authors.lastname: Cereda
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Søren
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
authors.forename: Bruce C V
authors.initials: BCV
authors.lastname: Campbell
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Mishra
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.affiliation: Department of Neurology, John Hunter Hospital, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: Department of Neurology, John Hunter Hospital, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.affiliation: Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA lansberg@stanford.edu.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
mesh_terms: D000465:Algorithms; D019985:Benchmarking; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D011237:Predictive Value of Tests; D012984:Software; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D013997:Time Factors
keywords: Cerebrovascular disease; brain imaging; brain ischemia; cerebral blood flow measurement; diffusion weighted MRI