Validation of a Novel Multiphase CTA Perfusion Tool Compared to CTP in Patients With Suspected Acute Ischemic Stroke
Notice bibliographique
Résumé
Background We recently developed a novel machine learning‐based algorithm using multiphase computed tomography angiography (mCTA) to generate perfusion maps of the brain, similar to computed tomography perfusion (CTP) (ie, multiphase CTA perfusion [mCTAp]). Here, we aim to validate the clinical utility of mCTAp in detection of brain ischemia and its side, extent, and location. Methods In this prospective multi‐reader‐multi‐case analysis, we included baseline images: mCTAp ( StrokeSENS ‐algorithm) and CTP (4D; GE Healthcare) from 121 randomly selected patients whose scans were not part of algorithm‐development. After excluding 2/121 scans because of poor image‐quality, 3 experienced radiologists read time to maximum, and relative cerebral blood flow‐maps generated by the test (mCTAp) and reference (CTP) modality. The 2 reading sessions were separated by 5 days although the reading order was randomized. Core laboratory imaging assessments – that used non contrast computed tomography, mCTA, and CTP – were considered as ground‐truth. A mixed‐effects statistical model with “reader” as random effects variable was used to calculate the area under the curve (with 95% CI), sensitivity, and specificity for both modalities (mCTAp/CTP) for ischemia detection, affected side, and occlusion location. The time required for interpretation and inter‐rater variability in assessments were compared across the 2 modalities. Results Area under the curves (95% CI) for detecting ischemia using mCTAp and CTP were 0.85 (95% CI, 0.8–0.9) and 0.84 (0.8–0.9) respectively ( P =0.43). Area under the curves for the affected side were 0.94 (0.92–0.97) and 0.96 (0.94–0.98) ( P =0.69), respectively; for detecting large vessel occlusion were 0.84 (0.8–0.9) and 0.86 (0.8–0.9), ( P =0.31), respectively; M2‐or‐distal occlusion were 0.79 (0.73–0.84) and 0.88 (0.83–0.92) ( P =0.22), respectively, for anterior cerebral artery‐occlusion 0.82 (0.66–0.98) and 0.93 (0.82–1.00) ( P =0.15), respectively, and for posterior cerebral artery‐occlusions 0.9 (0.8–1) and 0.99 (0.98–0.99) ( P =0.01), respectively. The median (interquartile range [IQR]) time for image interpretation was 62 seconds (IQR, 46–78) and 59 seconds (IQR, 42–69) for mCTAp and CTP, respectively, ( P =0.15). Fleiss` Kappa‐values for inter‐rater reliability in detecting ischemia were 0.5 and 0.8 for mCTAp and CTP, respectively. Conclusion mCTAp shows similar performance and interpretation times compared to CTP in assisting readers to detect brain ischemia, affected side, and occlusion location, but mainly as it relates to proximal vessel occlusions. The proposed tool still needs further refinement for distal vessel occlusions. Nonetheless, mCTAp is a promising tool as it allows for acquisition of brain perfusion maps with lower radiation exposure, acquisition time, and contrast dose compared with additional CTP.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».