Comparison of automated infarct core volume measures between non-contrast computed tomography and perfusion imaging...

Patients with small core infarction and salvageable penumbra are likely to benefit from endovascular treatment (EVT). As computed tomography perfusion imaging (CTP) is not always available 24/7 for patient selection, many patients are transferred to stroke centers for CTP. We compared automatically measured infarct core volume (NCCT_core) from the non-contrast computed tomography (NCCT) with ischemic core volume (CTP_core) from CTP and the outcome of EVT to clarify if NCCT_core measurement alone is sufficient to identify patients that benefit from transfer to stroke centers for EVT.

We included all consecutive stroke-code patients imaged with both NCCT and CTP at Helsinki University Hospital during 9/2016-01/2018. NCCT_core and CTP_core volumes were automatically calculated from the acute NCCT images. Follow-up infarct volume (FIV) was measured from 24 h follow-up NCCT to evaluate efficacy of EVT. To study whether NCCT_core could be used to identify patients eligible to EVT, we sub-grouped patients based on NCCT_core volumes (>50 mL and ≥ 70 mL).

Out of 1743 patients, baseline NCCT_core, CTP_core and follow-up NCCT was available for 288 patients. Median time from symptom onset to baseline imaging was 74 min (IQR 52-118), and time to follow-up imaging 24.15 h (22.25-26.33). Baseline NCCT_core was 20 mL (10-42), CTP_core 4 mL (0-16), and FIV 5 mL (1-49). Out of 288 patients, 23 had NCCT_core ≥ 70 mL and 26 had CTP_core ≥ 70 mL. NCCT_core and CTP_core performed similarly well in predicting large FIV (≥70 ml).

NCCT_core is a promising tool to identify patients that are not eligible to EVT due to large ischemic cores at baseline imaging.