Comparison of different methods of thrombus permeability measurement and impact on recanalization in the INTERRSeCT multinational multicenter prospective cohort study

Authors	GENSICKE H. EVANS J. W. AL AJLAN F. S. DOWLATSHAHI D. NAJM M. CALLEJA A. L. PUIG J. SOHN S .L. AHN S. H. POPPE A. Y. MIKULÍK Robert ASDAGHI N. FIELD T. S. JIN A. ASIL T. BOULANGER J. M. HILL M. D. GOYAL M. DEMCHUK A. M. MENON B. K.
Year of publication	2020
Type	Article in Periodical
Magazine / Source	NEURORADIOLOGY
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://link.springer.com/article/10.1007%2Fs00234-019-02320-y
Doi	http://dx.doi.org/10.1007/s00234-019-02320-y
Keywords	Acute ischemic stroke; Thrombus permeability; Recanalization therapies; NCCT; CTA
Description	Purpose To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. Methods Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (Delta HUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). Results Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax >= 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2-64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0-20.6) when HUmax <= 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1-4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). Conclusion Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.