Estimation of Acute Infarct Volume with Reference Maps: A Simple Visual Tool for Decision Making in Thrombectomy Cases
- Author:
Dong Eog KIM
1
;
Wi Sun RYU
;
Dawid SCHELLINGERHOUT
;
Han‐Gil JEONG
;
Paul KIM
;
Sang Wuk JEONG
;
Man Seok PARK
;
Kang Ho CHOI
;
Joon Tae KIM
;
Beom Joon KIM
;
Moon Ku HAN
;
Jun LEE
;
Jae Kwan CHA
;
Dae Hyun KIM
;
Hyun Wook NAH
;
Soo Joo LEE
;
Jae Guk KIM
;
Keun Sik HONG
;
Yong Jin CHO
;
Hong Kyun PARK
;
Byung Chul LEE
;
Kyung Ho YU
;
Mi Sun OH
;
Jong Moo PARK
;
Kyusik KANG
;
Kyung Bok LEE
;
Tai Hwan PARK
;
Sang Soon PARK
;
Yong Seok LEE
;
Hee Joon BAE
Author Information
- Publication Type:Original Article
- Keywords: Diffusion magnetic resonance imaging; Cerebral infarction; Thrombectomy; Infarct volume; Reference standards
- MeSH: Atherosclerosis; Cerebral Infarction; Decision Making; Diffusion Magnetic Resonance Imaging; Humans; Infarction; Medical Staff, Hospital; Methods; Middle Cerebral Artery; Sensitivity and Specificity; Stroke; Thrombectomy
- From:Journal of Stroke 2019;21(1):69-77
- CountryRepublic of Korea
- Language:English
- Abstract: 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.
