@article{1ac806c05ffd49c2ad61a08986392173,
title = "Recent administration of iodinated contrast renders core infarct estimation inaccurate using RAPID software",
abstract = "BACKGROUND AND PURPOSE: Automated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast. MATERIALS AND METHODS: We reviewed a prospective, single-center data base of 271 consecutive patients who underwent CTA 6 CTP for acute ischemic stroke from May 2018 through January 2019. Patients with emergent large-vessel occlusion confirmed by CTA in the extended window (.6 hours since last known well) and CTP with RAPID postprocessing were included. Two blinded raters independently assessed CT ASPECTS on NCCT performed at the time of CTP. RAPID software used relative cerebral blood flow of,30% as a surrogate for irreversible core infarct. Patients were dichotomized on the basis of receiving recent IV iodinated contrast (,8 hours before CTP) for a separate imaging study. RESULTS: The recent IV contrast and contrast-na{\"i}ve cohorts comprised 23 and 15 patients, respectively. Multivariate linear regression analysis demonstrated that recent IV contrast administration was independently associated with a decrease in the RAPID core infarct estimate (proportional increase = 0.34; 95% CI, 0.12-0.96; P =.04). CONCLUSIONS: Patients who received IV iodinated contrast in proximity (,8 hours) to CTA/CTP as part of a separate imaging study had a much higher likelihood of core infarct underestimation with RAPID compared with contrast-na{\"i}ve patients. Over-reliance on RAPID postprocessing for treatment disposition of patients with extended window emergent large-vessel occlusion should be avoided, particularly with recent IV contrast administration.",
author = "Copelan, {A. Z.} and Smith, {E. R.} and Drocton, {G. T.} and Narsinh, {K. H.} and D. Murph and Khangura, {R. S.} and Hartley, {Z. J.} and Abla, {A. A.} and Dillon, {W. P.} and Dowd, {C. F.} and Higashida, {R. T.} and Halbach, {V. V.} and Hetts, {S. W.} and Cooke, {D. L.} and K. Keenan and J. Nelson and D. McCoy and M. Ciano and Amans, {M. R.}",
note = "Funding Information: Received January 24, 2020; accepted after revision August 1. From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.), and Neurosurgery (A.A.A.), University of California, San Francisco, San Francisco, California; Department of Radiology (E.R.S.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Department of Neurology (K.K.), University of California Davis, Sacramento, California. Paper previously presented at: Annual Meeting of the Society of Neurointerventional Surgery, July 21–26, 2019; Miami, Florida. Research reported in this publication was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award No. R21DC016087-01A1 and the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R56HL149124-01. Funding Information: Disclosures: Steven W. Hetts—UNRELATED: Consultancy: Route 92 Medical, Comments: clinical trial clinical event evaluator for thrombectomy device company; Grants/Grants Pending: Siemens, Stryker, MicroVention, Terumo, Comments: research contract for advanced angiography suites, core imaging lab for aneurysm treatment clinical trials*; Stock/Stock Options: ThrombX, Comments: investor in startup thrombectomy device company. Jeffrey Nelson—RELATED: Grant: National Institutes of Health.* Matthew R. Amans—RELATED: Grant: National Institutes of Health, Comments: Research reported in this publication was supported by the National Institute of Deafness and Other Communication Disorders R21DC016087-01A1 and the National Heart, Lung, and Blood Institute R56HL149124-01*; UNRELATED: Consultancy: Covidien, Stryker, MicroVention; Expert Testimony: various medicolegal consulting. *Money paid to the institution.",
year = "2020",
month = dec,
day = "1",
doi = "10.3174/ajnr.A6908",
language = "English (US)",
volume = "41",
pages = "2235--2242",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "12",
}