Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect.
BACKGROUND
Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance.


OBJECTIVE
To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type.


METHODS
Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions.


RESULTS
The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct.


CONCLUSIONS
Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment.
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.|Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands.
A M M
http://orcid.org/0000-0002-3950-1561
AM
Boers
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
O A
OA
Berkhemer
Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.
C H
http://orcid.org/0000-0001-6544-4567
CH
Slump
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
W H
WH
van Zwam
Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
Y B W E M
YB
Roos
Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
A
http://orcid.org/0000-0002-6159-2228
A
van der Lugt
Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
R J
http://orcid.org/0000-0003-1032-9099
RJ
van Oostenbrugge
Division of Neurointervention, Texas Stroke Institute, Plano, Texas, USA.
A J
AJ
Yoo
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
D W J
http://orcid.org/0000-0002-9234-3515
DW
Dippel
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands.
H A
HA
Marquering
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
C B L M
CB
Majoie
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D001931:Brain Mapping / Q000379:methods*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome
Brain; CT; Stroke; Technology; Thrombectomy