Is infarct core growth linear? Infarct volume estimation by computed tomography perfusion imaging

Suomalainen, Olli; Abou, Ahmed Elseoud; Martinez‐Majander, Nicolas; Tiainen, Marjaana; Valkonen, Kati; Virtanen, Pekka; Forss, Nina; Curtze, Sami

doi:10.1111/ane.13601

Acta Neuro Scandinavica

2022

DOI: 10.1111/ane.13601

|View full text |Cite

Is infarct core growth linear? Infarct volume estimation by computed tomography perfusion imaging

Olli Suomalainen

Ahmed Elseoud Abou

Nicolas Martinez‐Majander

et al.

Abstract: Objectives: Current guidelines for recanalization treatment are based on the time elapsed between symptom onset and treatment and visualization of existing penumbra in computed tomography perfusion (CTP) imaging. The time window for treatment options relies on linear growth of infarction although individual infarct growth rate may vary. We aimed to test how accurately the estimated follow-up infarct volume (eFIV) can be approximated by using a linear growth model based on CTP baseline imaging. If eFIV did not … Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2022

2023

Publication Types

Select...

Article3

Relationship

Self Cite0

Independent3

Authors

Journals

Cited by 3 publications

(1 citation statement)

References 32 publications

(154 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some studies have assumed both linear 11 and logarithmic 12 infarct growth (IG), but it is currently under discussion. 13 All these factors highlight the need for further research to improve tissue-outcome predictions in patients with stroke. 14 Here, we studied the best thresholds for defining ischemic core using global-versus GM-and WM-specific CBF thresholds and accounting for IG in a cohort of patients with baseline CTP, complete reperfusion, and follow-up MR imaging.…”

mentioning

confidence: 99%

Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds

Rodríguez-Vázquez¹,

Laredo²,

Renú

et al. 2022

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: CTP allows estimating ischemic core in patients with acute stroke. However, these estimations have limited accuracy compared with MR imaging. We studied the effect of applying WM-and GM-specific thresholds and analyzed the infarct growth from baseline imaging to reperfusion. MATERIALS AND METHODS:This was a single-center cohort of consecutive patients (n ¼ 113) with witnessed strokes due to proximal carotid territory occlusions with baseline CT perfusion, complete reperfusion, and follow-up DWI. We segmented GM and WM, coregistered CTP with DWI, and compared the accuracy of the different predictions for each voxel on DWI through receiver operating characteristic analysis. We assessed the yield of different relative CBF thresholds to predict the final infarct volume and an estimated infarct growth-corrected volume (subtracting the infarct growth from baseline imaging to complete reperfusion) for a single relative CBF threshold and GM-and WM-specific thresholds. RESULTS:The fixed threshold underestimated lesions in GM and overestimated them in WM. Double GM-and WM-specific thresholds of relative CBF were superior to fixed thresholds in predicting infarcted voxels. The closest estimations of the infarct on DWI were based on a relative CBF of 25% for a single threshold, 35% for GM, and 20% for WM, and they decreased when correcting for infarct growth: 20% for a single threshold, 25% for GM, and 15% for WM. The combination of 25% for GM and 15% for WM yielded the best prediction.CONCLUSIONS: GM-and WM-specific thresholds result in different estimations of ischemic core in CTP and increase the global accuracy. More restrictive thresholds better estimate the actual extent of the infarcted tissue.ABBREVIATIONS: ICC ¼ intraclass correlation coefficient; IG ¼ infarct growth; IQR ¼ interquartile range; rCBF ¼ relative CBF C TP is a widely available technique that allows measuring hypoperfused brain tissue and estimating ischemic core in patients with acute stroke. [1][2][3] The ischemic core is often defined by CBF thresholds. 4 However, despite their clinical usefulness, the most often used CBF-based definitions of ischemic core may not be accurate for research purposes. 5 They often overestimate the true infarct 6 (example in the Online Supplemental Data) and have limited accuracy compared with MR imaging. 7 In addition, differences in the neurochemical response to ischemia in GM and WM lead to a varied vulnerability to ischemia. 8 Applying homogeneous CBF thresholds in the whole brain may result in under-or overestimating the lesion in brain areas with different susceptibility to ischemia. 9 Also, ischemic core volumes estimated by CTP, especially those affecting WM, are often smaller than in follow-up MR imaging. 10 This overestimation, applied to routine clinical practice, could lead to not offering reperfusion treatment to patients who could benefit from it. These findings can be explained by the delay between baseline imaging and the followup imaging used to measure final infarct volume. The b...

show abstract

mentioning

confidence: 99%

Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds

Rodríguez-Vázquez¹,

Laredo²,

Renú

et al. 2022

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

Association between intraprocedural drops in blood pressure and infarct growth rate patterns after acute large-vessel occlusions

Galecio-Castillo,

Quispe-Orozco,

Farooqui

et al. 2023

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundInfarct growth rate (IGR) differs among patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS), and this variability has critical clinical repercussions. We explored IGR patterns and their association with blood pressure during endovascular therapy (EVT).MethodsThis is a two-center cohort observational study that included consecutive anterior circulation LVO-AIS patients who underwent EVT and achieved modified Thrombolysis in Cerebral Infarction (mTICI) 2 c-3. Initial and final infarct volumes (FIV) were defined using admission computed tomography perfusion (CTP) defined as relative cerebral blood flow (rCBF) <30%, and diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) at 24 hours post-EVT. We categorized IGR patterns as exponential (ExpIGR) and Non-exponential (NonExp) based on their growth curves. We then dichotomized ExpIGR clinical significance based on the association of infarct growth with 90-day Modified Rankin Score (mRS) as ExpIGR-A (>13 mL) and ExpIGR-B (<13 mL). Intraprocedural blood pressure (BP) drops were calculated as the difference between median arterial pressure (MAP) at admission and the lowest intraprocedural MAP reading before recanalization, and the area between admission MAP threshold and all lower measurements of intraprocedural MAP. Logistic and linear regression were used to investigate associations between variables of interest.ResultsOf 159 modified Thrombolysis in Cerebral Infarction (mTICI) 2 c-3 patients, we found that 36% demonstrated ExpIGR-A, 31% ExpIGR-B, and 32.7% NonExp patterns. The Exp-A and Exp-B groups differed significantly in National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), glucose, and FIV. The Exp-A and NonExp groups differed in rCBF <30% vol, and time of stroke onset (SO) to admission CTP; and the Exp-B and NonExp groups in NIHSS, rCBF <30%, Tmax <6 s volume, collateral flow measured by hypoperfusion intensity ratio (HIR), and FIV. Hypotensive MAP area (HMA) was independently associated with an ExpIGR-A pattern. Infarct volume increased by 1 mL per 100 units of hypotensive area and 4.2 mL per 0.1 units of HIR, with a significant interaction between both variables.ConclusionAfter an LVO-AIS, the IGR can be differentiated into two distinct exponential and non-exponential patterns. A subgroup of patients with the exponential pattern experienced clinically meaningful infarct growth rates between CTP acquisition and reperfusion and seem to be highly vulnerable to episodes of sustained intraprocedural BP drops during EVT.

show abstract

Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study

Shen

Liao

Jiang

et al. 2022

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Objective To investigate the impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on CTP infarct core volume and poor 90-day functional outcomes in acute ischemic stroke (AIS). Methods A total of 403 hospitalized patients with AIS in the Stroke Center of the First Hospital Affiliated to Soochow University were enrolled from March 2018 to January 2021. The association between NT-proBNP and clinical outcomes in acute ischemic patients was assessed by logistic regression and adjusted for confounding factors. Also, subgroup analyses were conducted based on treatment decisions. Results NT-proBNP was positively correlated with CTP ischemic volume (p < 0.001), infarct core volume (p < 0.001), and ischemic penumbra volume (p < 0.001). Univariate analysis showed that the influence of NT-proBNP and functional outcomes were statistically significant in model 1 (p = 0.002). This phenomenon was persistent after adjusted for age, sex, and body mass index in model 2 (p = 0.011), adjusted for SBP, current smoking, family history of stroke, hypertension, and diabetes mellitus in model 3 (p < 0.001), and adjusted for TnI, D-dimer, PLT, Cr, TC, TG, HDL-C, treatment decisions, and NIHSS score in model 4 (p = 0.027). A high NT-proBNP was associated with a high 90-days mRS score among the total population, IV rt-PA, and standardized treatment groups, but not in IV rt-PA + EVT, EVT, and EVT/IV rt-PA + EVT groups. Conclusion Elevated NT-proBNP levels reveal large CTP infarct core volume and poor 90-day functional outcome in AIS. NT-pro BNP is an independent risk factor for functional outcomes.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Is infarct core growth linear? Infarct volume estimation by computed tomography perfusion imaging

Cited by 3 publications

References 32 publications

Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds

Optimizing the Definition of Ischemic Core in CT Perfusion: Influence of Infarct Growth and Tissue-Specific Thresholds

Association between intraprocedural drops in blood pressure and infarct growth rate patterns after acute large-vessel occlusions

Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study

Contact Info

Product

Resources

About