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KMID : 1142120190210010069
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Journal of Stroke
2019 Volume.21 No. 1 p.69 ~ p.77
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Estimation of Acute Infarct Volume with Reference Maps: A Simple Visual Tool for Decision Making in Thrombectomy Cases
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Kim Dong-Eog
Ryu Wi-Sun
Schellingerhout Dawid
Jeong Han-Gil
Kim Paul
Jeong Sang-Wuk
Park Man-Seok
Choi Kang-Ho
Kim Joon-Tae
Kim Beom-Joon
Han Moon-Ku
Lee Jun
Cha Jae-Kwan
Kim Dae-Hyun
Nah Hyun-Wook
Lee Soo-Joo
Kim Jae-Guk
Hong Keun-Sik
Cho Yong-Jin
Park Hong-Kyun
Lee Byung-Chul
Yu Kyung-Ho
Oh Mi-Sun
Park Jong-Moo
Kang Kyu-Sik
Lee Kyung-Bok
Park Tai-Hwan
Park Sang-Soon
Lee Yong-Seok
Bae Hee-Joon
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Abstract
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Background and Purpose: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources.
Methods: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume.
Results: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis -15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes (<21, <31, and <51 mL) were very high (all about >90%).
Conclusions: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
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KEYWORD
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Diffusion magnetic resonance imaging, Cerebral infarction, Thrombectomy, Infarct volume, Reference standards
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