Computed Tomography Perfusion Core Infarct Measurement Compared to Diffusion-Weighted Magnetic Resonance Imaging in Patients with Revascularization of Anterior Circulation, Large Artery Occlusion Ischemic Stroke

Abstract

Relative cerebral blood flow (CBF) < 30% has been identified as a predictor of infarct core on computed tomography perfusion (CTP). We investigated the relationship between CTP-predicted infarct core and diffusion-weighted imaging magnetic resonance imaging (DWI MRI). We conducted a retrospective analysis comparing infarct core (CBF < 30%; RAPID iSchemaView) and post-revascularization DWI MRI (ADC < 620 cc; RAPID iSchemaView) in patients with internal carotid artery (ICA) or proximal middle cerebral artery (MCA) stroke between November 2016 and May 2019. Included subjects had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or better and presented within 24 h of last known well (LKW) time. Two hundred one cases were identified. Mean duration from LKW time to CTP and MRI was 4.3 and 28.6 h, respectively. Median ischemic core volume was 8 cc, and median MRI infarct volume was 17 cc. CTP core volume showed fair correlation with MRI infarct volume (r = 0.294, p < 0.0001). There was a stronger association between CBF < 30% and DWI MRI in subjects presenting beyond 6 h (r = 0.359, p = 0.011). In a multivariate analysis, greater volumetric difference was associated with younger age (p = 0.001), longer duration from LKW time to revascularization time (p < 0.020), and longer CTP to revascularization time (p < 0.0001). Reduced relative CBF < 30% is a fair measure of infarct size within 24 h of anterior circulation, large artery occlusion (LAO) stroke when adequate reperfusion is achieved.

Automated CT Perfusion Detection of the Acute Infarct Core in Ischemic Stroke: A Systematic Review and Meta-Analysis

“…A search of the references of included studies and previous systematic reviews [17, 18, 20, 21] identified 4 additional studies. A total of 167 full-text papers were reviewed and 48 studies [8, 12‒14, 29‒72] met the inclusion criteria (Fig. 1).…”

A Telestroke Nurse and Neuroradiologist Model for Extended Window Code Stroke Triage

“…Clinical and radiological outcome data from our network have been published. [11][12][13][14][15][16][17] We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021). We included all adult patients with suspected stroke symptoms presenting to one of our stroke network's nonthrombectomy facilities within 4.5 to 24 hours of LKW.…”

“…Our system includes 2 Joint Commission–certified thrombectomy centers: one is a comprehensive stroke center, and the other is thrombectomy capable certified. Clinical and radiological outcome data from our network have been published 11–17. We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021).…”