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Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic Stroke.

Christopher D d'Esterre1, Mari E Boesen1, Seong Hwan Ahn1

  • 1From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F., M.G., B.K.M.); Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada (C.D.d'E., M.E.B., S.H.A., M.N., R.F., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.); Department of Clinical Neurosciences, University of Western Ontario, London, Ontario, Canada (A.V.K.); and Department of Neurosciences, University Hospital, Modena, Italy (A.Z.).

Stroke
|October 31, 2015
PubMed
Summary

Computed tomographic perfusion (CTP) thresholds for acute ischemic stroke predict follow-up infarction. Optimal thresholds depend on reperfusion time, guiding treatment decisions for stroke patients.

Keywords:
CTacute ischemic strokeendovascular therapyinfarctionperfusion

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Acute ischemic stroke requires timely intervention.
  • Computed tomographic perfusion (CTP) is crucial for assessing stroke severity.
  • Predicting infarct evolution is vital for treatment planning.

Purpose of the Study:

  • Determine CTP thresholds linked to follow-up infarction.
  • Analyze thresholds based on stroke onset-to-CTP and CTP-to-reperfusion times.
  • Establish optimal CTP parameters for acute ischemic stroke management.

Main Methods:

  • Included 132 acute ischemic stroke patients with arterial occlusion.
  • Used CTP, noncontrast CT, and MRI diffusion-weighted imaging.
  • Analyzed Tmax, cerebral blood flow (CBF), and cerebral blood volume (CBV) using ROC curves.
  • Assessed reperfusion via angiography and CTP-to-reperfusion intervals.

Main Results:

  • Specific Tmax and CBF thresholds predicted infarct in early reperfusion (<90 min) after stroke onset (<180 min).
  • Cerebral blood volume showed modest discriminative ability.
  • No significant association between onset-to-CTP time and optimal thresholds.
  • CTP-to-reperfusion time significantly influenced optimal thresholds for CBF and Tmax.

Conclusions:

  • Optimal CTP thresholds for predicting infarct in acute ischemic stroke are time-dependent.
  • Reperfusion time is a critical factor in interpreting CTP findings.
  • CTP parameters, particularly Tmax and CBF, require adjustment based on reperfusion timing.