Comparison of 10 TTP and Tmax estimation techniques for MR perfusion-diffusion mismatch quantification in acute stroke

Abstract

Background and purpose: The mismatch between lesions identified in perfusion- and diffusion-weighted MR imaging is typically used to identify tissue at risk of infarction in acute stroke. The purpose of this study was to analyze the variability of mismatch volumes resulting from different time-to-peak or time-to-maximum estimation techniques used for hypoperfused tissue definition.

Materials and methods: Data of 50 patients with middle cerebral artery stroke and intracranial vessel occlusion imaged within 6 hours of symptom onset were analyzed. Therefore, 10 different TTP/Tmax techniques and delay thresholds between +2 and +12 seconds were used for calculation of perfusion lesions. Diffusion lesions were semiautomatically segmented and used for mismatch quantification after registration.

Results: Mean volumetric differences up to 40 and 100 mL in individual patients were found between the mismatch volumes calculated by the 10 TTP/Tmax estimation techniques for typically used delay thresholds. The application of typical criteria for the identification of patients with a clinically relevant mismatch volume resulted in different mismatch classifications in ≤24% of all cases, depending on the TTP/Tmax estimation method used.

Conclusions: High variations of tissue-at-risk volumes have to be expected when using different TTP/Tmax estimation techniques. An adaption of different techniques by using correction formulas may enable more comparable study results until a standard has been established by agreement.

Fig 1.

Selected section from a PWI dataset (left) and concentration time curve (black dotted) for a location within the perfusion lesion (arrow) with fitted hemodynamic model curves: γ-variate model (red), local density random walk model (green), log-normal model (magenta), and reference-based linear curve fit model (blue).

Fig 2.

Selected section from a DWI dataset with a corresponding DWI lesion (black) and overlaid tissue-at-risk volumes for delay thresholds between 2 and 12 seconds calculated by using the 10 different TTP/Tmax estimation methods.