{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:14:01Z","timestamp":1774620841672,"version":"3.50.1"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">We recently developed a novel machine learning\u2010based algorithm using multiphase computed tomography angiography (mCTA) to generate perfusion maps of the brain, similar to computed tomography perfusion (CTP) (ie, multiphase CTA perfusion [mCTAp]). Here, we aim to validate the clinical utility of mCTAp in detection of brain ischemia and its side, extent, and location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this prospective multi\u2010reader\u2010multi\u2010case analysis, we included baseline images: mCTAp (\n                      <jats:italic toggle=\"yes\">StrokeSENS<\/jats:italic>\n                      \u2010algorithm) and CTP (4D; GE Healthcare) from 121 randomly selected patients whose scans were not part of algorithm\u2010development. After excluding 2\/121 scans because of poor image\u2010quality, 3 experienced radiologists read time to maximum, and relative cerebral blood flow\u2010maps generated by the test (mCTAp) and reference (CTP) modality. The 2 reading sessions were separated by 5 days although the reading order was randomized. Core laboratory imaging assessments \u2013 that used non contrast computed tomography, mCTA, and CTP \u2013 were considered as ground\u2010truth. A mixed\u2010effects statistical model with \u201creader\u201d as random effects variable was used to calculate the area under the curve (with 95% CI), sensitivity, and specificity for both modalities (mCTAp\/CTP) for ischemia detection, affected side, and occlusion location. The time required for interpretation and inter\u2010rater variability in assessments were compared across the 2 modalities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Area under the curves (95% CI) for detecting ischemia using mCTAp and CTP were 0.85 (95% CI, 0.8\u20130.9) and 0.84 (0.8\u20130.9) respectively\u00a0(\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.43). Area under the curves for the affected side were 0.94 (0.92\u20130.97) and 0.96 (0.94\u20130.98) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.69), respectively; for detecting large vessel occlusion were 0.84 (0.8\u20130.9) and 0.86 (0.8\u20130.9), (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.31), respectively; M2\u2010or\u2010distal occlusion were 0.79 (0.73\u20130.84) and 0.88 (0.83\u20130.92) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.22), respectively, for anterior cerebral artery\u2010occlusion 0.82 (0.66\u20130.98) and 0.93 (0.82\u20131.00) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.15), respectively, and for posterior cerebral artery\u2010occlusions 0.9 (0.8\u20131) and 0.99 (0.98\u20130.99) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01), respectively. The median (interquartile range [IQR]) time for image interpretation was 62 seconds (IQR, 46\u201378) and 59 seconds (IQR, 42\u201369) for mCTAp and CTP, respectively, (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.15). Fleiss` Kappa\u2010values for inter\u2010rater reliability in detecting ischemia were 0.5 and 0.8 for mCTAp and CTP, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p xml:lang=\"en\">mCTAp shows similar performance and interpretation times compared to CTP in assisting readers to detect brain ischemia, affected side, and occlusion location, but mainly as it relates to proximal vessel occlusions. The proposed tool still needs further refinement for distal vessel occlusions. Nonetheless, mCTAp is a promising tool as it allows for acquisition of brain perfusion maps with lower radiation exposure, acquisition time, and contrast dose compared with additional CTP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.122.000811","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T02:47:46Z","timestamp":1679626066000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Validation of a Novel Multiphase CTA Perfusion Tool Compared to CTP in Patients With Suspected Acute Ischemic Stroke"],"prefix":"10.1161","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1043-1125","authenticated-orcid":false,"given":"Faysal","family":"Benali","sequence":"first","affiliation":[{"name":"Cumming School of Medicine","place":["Calgary, Canada"]},{"name":"Maastricht University Medical Center+ (MUMC+)","place":["Maastricht, the Netherlands"]},{"name":"University of Calgary","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine","place":["Calgary, Canada"]},{"name":"University of Calgary","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najratun","family":"Nayem Pinky","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fouzi","family":"Bala","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine","place":["Calgary, Canada"]},{"name":"University of Calgary","place":["Calgary, Canada"]},{"name":"University Hospital of Tours","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Alhabli","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine","place":["Calgary, Canada"]},{"name":"University of Calgary","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rotem","family":"Golan","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis A.","family":"Souto Maior Neto","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibukun","family":"Elebute","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Duszynski","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wu","family":"Qiu","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine","place":["Calgary, Canada"]},{"name":"University of Calgary","place":["Calgary, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713973"},{"issue":"1","key":"e_1_3_2_3_2","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMoa1706442","article-title":"Saver aTGJ, for the DAWN Trial Investigators*. 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