Infarct Core Reliability by CT Perfusion is a Time-Dependent Phenomenon.
Acute ischemic stroke
cerebral blood flow
cerebral blood volume computed tomography perfusion
ghost infarct core
Journal
Journal of neuroimaging : official journal of the American Society of Neuroimaging
ISSN: 1552-6569
Titre abrégé: J Neuroimaging
Pays: United States
ID NLM: 9102705
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
07
12
2019
revised:
19
01
2020
accepted:
21
01
2020
pubmed:
11
2
2020
medline:
15
12
2020
entrez:
11
2
2020
Statut:
ppublish
Résumé
In the setting of an extended time window for endovascular treatment (EVT) for acute stroke patients, computed tomography perfusion (CTP) has become a major tool in patient selection. However, there are some data suggesting that the initial ischemic core may be overestimated by CTP depending on stroke onset time. This study aims to evaluate possible predictors of overestimation of infarct core by CTP. We studied all consecutive stroke patients undergoing EVT during 1 year who underwent CTP at admission and had a successful recanalization. Admission infarct core was measured on cerebral blood volume maps generated using the Intellispace Portal (Philips Healthcare, Best, the Netherlands) and final infarct was measured on noncontrast follow-up computed tomography at 24 hours. We defined overestimation of the infarct core as initial core minus final infarct >10 mL. Out of 107 patients undergoing EVT in the study period, 60 were anterior circulation and had CTP done at our institute, and of them 31 were compatible with the inclusion criteria (known time of onset, no hemorrhagic conversion, and good recanalization). Median National Institute of Health Stroke Scale on admission was 13. Median time from symptoms to CTP was 148 minutes. Seventeen patients were found to have overestimation of the infarct core. Logistic regression analyses showed time from symptom onset to CTP to be inversely related to overestimation with a cutoff of 170 minutes (sensitivity 94% and specificity 43%). Over estimation of the infarct core by CTP in patients undergoing EVT is time dependent and so CTP results among early arrivers should be interpreted cautiously.
Sections du résumé
BACKGROUND AND PURPOSE
In the setting of an extended time window for endovascular treatment (EVT) for acute stroke patients, computed tomography perfusion (CTP) has become a major tool in patient selection. However, there are some data suggesting that the initial ischemic core may be overestimated by CTP depending on stroke onset time. This study aims to evaluate possible predictors of overestimation of infarct core by CTP.
METHODS
We studied all consecutive stroke patients undergoing EVT during 1 year who underwent CTP at admission and had a successful recanalization. Admission infarct core was measured on cerebral blood volume maps generated using the Intellispace Portal (Philips Healthcare, Best, the Netherlands) and final infarct was measured on noncontrast follow-up computed tomography at 24 hours. We defined overestimation of the infarct core as initial core minus final infarct >10 mL.
RESULTS
Out of 107 patients undergoing EVT in the study period, 60 were anterior circulation and had CTP done at our institute, and of them 31 were compatible with the inclusion criteria (known time of onset, no hemorrhagic conversion, and good recanalization). Median National Institute of Health Stroke Scale on admission was 13. Median time from symptoms to CTP was 148 minutes. Seventeen patients were found to have overestimation of the infarct core. Logistic regression analyses showed time from symptom onset to CTP to be inversely related to overestimation with a cutoff of 170 minutes (sensitivity 94% and specificity 43%).
CONCLUSION
Over estimation of the infarct core by CTP in patients undergoing EVT is time dependent and so CTP results among early arrivers should be interpreted cautiously.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
240-245Informations de copyright
© 2020 by the American Society of Neuroimaging.
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