Zeitschrift für klinische und experimentelle Pathologie

Abstrakt

Inter-Threshold Agreement for Infarct Lesion Volume According to the Apparent Diffusion Coefficient

Arnaud Bufacchi, F Zhu, B Gory, G Hossu, E Micard, R Anxionnat, S Bracard, B Chen

Background and purpose: ADC threshold-based computer mapping provide pertinent ischemic stroke volume. Indeed, pre-treatment lesional volume appears to be an independent predictor for functional outcome in AIS with proximal intracranial large vessel occlusion.

The aim of this study is to determine volumetric agreement between Olea Sphere^® and our homemade software named Strike^® using three different ADC thresholds (600, 615, 620 mm²/s) to evaluate the influence on functional outcomes of patients with AIS treated by Mechanical Thrombectomy Combined with Intravenous Thrombolysis (IVTMT).

Methods: 101 patients from THRACE (Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke) were included. AIS were segmented from Olea Sphere^® with an ADC threshold of 600 × 10^-6 mm²/s, and with Strike^® with 615 × 10^-6 mm²/s and 620 × 10^-6 mm²/s.

The primary study outcome was to compare the AIS’s mean volumes obtained with these different ADC thresholds. Secondary outcome was to determinate if this AIS volumes can be predicting functional prognosis which favourable outcomes: mRS=0-2 at 3 months.

Result: AIS’s volumes differences for each ADC thresholds were: Sphere^® (600 mm²/s) and Strike^® (615 mm²/s)=6.1200 (p-value: 0.6405), Sphere (600 mm²/s) and Strike^® (620 mm²/s)=-11.0476 (p=0.0776) and Strike^® (615 mm²/s) and Strike^® (620 mm²/s)=-4.9276 (p=0.9562). The observed association between ADC 600 mm²/s (Sphere^®) and functional outcome remained significant (p=0.0448). ADC 615 mm²/s and ADC 620 mm²/s remained not statistically significant (Respectively p=0.0987 and p=0.0692).

Conclusion: Several currently ADC thresholds for the measurement of AIS volume estimation are highly comparable and can be helpful before therapeutic decisions. However, some discrepancies can be found when correlating to the functional prognosis according to the ADC threshold for patients treated by Mechanical Thrombectomy Combined with Intravenous Thrombolysis (IVTMT).