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

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Accurate prediction of the infarct core in acute ischemic stroke is crucial for patient prognosis and treatment decisions.
• Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) are established methods for infarct core assessment.
• CT perfusion (CTP) offers a potential automated alternative for infarct core evaluation.

Approach:

• A systematic review and meta-analysis was conducted, searching MEDLINE and EMBASE from 1960 to December 2020.
• Included studies were analyzed based on volumetric difference, volumetric correlation, sensitivity, specificity, and Dice coefficient.
• Random-effects meta-analysis was performed for volumetric difference and correlation outcomes.

Key Points:

• In anterior circulation strokes, no significant volumetric differences were found between CTP and acute or delayed DWI/FLAIR.
• High correlations were observed between CTP and DWI for relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV).
• Limited evidence exists for posterior circulation or lacunar infarct strokes, and statistical analysis for voxel-level sensitivity/specificity was not possible.

Conclusions:

• Significant heterogeneity and a lack of high-quality studies limit the ability to reliably determine CTP's accuracy in predicting the infarct core.
• Insufficient evidence currently supports CTP as non-inferior to DWI or FLAIR for acute infarct core prediction.
• Further high-quality research is required to establish the definitive role of CTP in stroke imaging.