title: Automated Entire Thrombus Density Measurements for Robust and Comprehensive Thrombus Characterization in Patients with Acute Ischemic Stroke.
abstract: OBJECTIVE
  In acute ischemic stroke (AIS) management, CT-based thrombus density has been associated with treatment success. However, currently used thrombus measurements are prone to inter-observer variability and oversimplify the heterogeneous thrombus composition. Our aim was first to introduce an automated method to assess the entire thrombus density and then to compare the measured entire thrombus density with respect to current standard manual measurements.
  
  
  METHODS
  In 135 AIS patients, the density distribution of the entire thrombus was determined. Density distributions were described using medians, interquartile ranges (IQR), kurtosis, and skewedness. Differences between the median of entire thrombus measurements and commonly applied manual measurements using 3 regions of interest were determined using linear regression.
  
  
  RESULTS
  Density distributions varied considerably with medians ranging from 20.0 to 62.8 HU and IQRs ranging from 9.3 to 55.8 HU. The average median of the thrombus density distributions (43.5 ± 10.2 HU) was lower than the manual assessment (49.6 ± 8.0 HU) (p<0.05). The difference between manual measurements and median density of entire thrombus decreased with increasing density (r = 0.64; p<0.05), revealing relatively higher manual measurements for low density thrombi such that manual density measurement tend overestimates the real thrombus density.
  
  
  CONCLUSIONS
  Automatic measurements of the full thrombus expose a wide variety of thrombi density distribution, which is not grasped with currently used manual measurement. Furthermore, discrimination of low and high density thrombi is improved with the automated method.
authors.affiliation: Dept. of Radiology, Erasmus MC, Rotterdam, the Netherlands.|Dept. of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.|Dept. of Radiology, AMC, Amsterdam, the Netherlands.|Dept. of Biomedical Engineering and Physics, AMC, Amsterdam, the Netherlands.
authors.forename: Emilie M M
authors.initials: EM
authors.lastname: Santos
authors.affiliation: Dept. of Radiology, Erasmus MC, Rotterdam, the Netherlands.|Dept. of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.|Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands.
authors.forename: Wiro J
authors.initials: WJ
authors.lastname: Niessen
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Texas Stroke Institute, Plano, Texas, United States of America.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Dept. of Radiology, AMC, Amsterdam, the Netherlands.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: Dept. of Radiology, AMC, Amsterdam, the Netherlands.
authors.forename: Ludo F
authors.initials: LF
authors.lastname: Beenen
authors.affiliation: Dept. of Radiology, AMC, Amsterdam, the Netherlands.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: Dept. of Radiology, AMC, Amsterdam, the Netherlands.|Dept. of Biomedical Engineering and Physics, AMC, Amsterdam, the Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology*; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed