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 (ΔHUmax); [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.

Bezmialem Vakif Univesitesi Noroloji Istanbul Turkey

Calgary Stroke Program Departments of Clinical Neurosciences Radiology and Community Health Sciences Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada

Centre Hospitalier de l'Université de Montréal University of Montréal Montreal Québec Canada

Charles LeMoyne Hospital University of Sherbrooke Greenfield Park Canada

Department of Neurology Brain Research Institute Keimyung University School of Medicine Daegu Republic of Korea

Department of Neurology Chosun University School of Medicine Gwangju Republic of Korea

Dr Josep Trueta University Hospital Girona Spain

Gosford Hospital Gosford Australia

International Clinical Research Center Department of Neurology St Ann's University Hospital Masaryk University Brno Czech Republic

King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia

Miller School of Medicine University of Miami Miami Florida USA

Queen's University Kingston Ontario Canada

Stroke Center and Department of Neurology University Hospital Basel and University of Basel Basel Switzerland

Universidad de Valladolid Valladolid Spain

University of British Columbia Vancouver British Columbia Canada

University of Ottawa Ottawa Ontario Canada

Neuroradiology. 2020 Feb;62(2):137. doi: 10.1007/s00234-019-02340-8. PubMed

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