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Related Experiment Video

Updated: Jul 7, 2025

A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
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Redefining CT perfusion-based ischemic core estimates for the ghost core in early time window stroke.

Manisha Koneru1, Meisam Hoseinyazdi2, Dhairya A Lakhani2

  • 1Cooper Medical School of Rowan University, Camden, New Jersey, USA.

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
|December 25, 2023
PubMed
Summary

In large vessel occlusion stroke, relative cerebral blood flow volumes correlate with recovery. Current thresholds for ischemic core may limit treatment for some early window stroke patients.

Keywords:
cerebrovascular circulationcomputed tomography perfusionischemic strokethrombectomytreatment outcome

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Large vessel occlusion (LVO) stroke treatment relies on imaging thresholds.
  • Early window LVO stroke may have salvageable tissue overestimated by infarct volume.
  • This can lead to exclusion of patients who might benefit from intervention.

Purpose of the Study:

  • To explore the relationship between pretreatment CT parameters and clinical outcomes in early window LVO stroke.
  • To assess the strength of correlations between relative cerebral blood flow (rCBF) volumes and patient outcomes.

Main Methods:

  • Analysis of patients from a prospective registry at two sites.
  • Inclusion criteria: LVO, within 3 hours of last known well, successful reperfusion.
  • Outcomes: short-term neurological (NIHSS change) and long-term (90-day mRS). Spearman's correlations were used.

Main Results:

  • 73 patients were analyzed; median age 66 years.
  • rCBF<30%, rCBF<34%, and rCBF<38% volumes significantly correlated inversely with NIHSS change (p<.048).
  • No other pretreatment imaging parameters showed significant correlation with outcomes.

Conclusions:

  • Favorable short-term neurological recovery in early window LVO stroke is correlated with rCBF volumes.
  • The modest correlation strength suggests limitations in applying general ischemic core thresholds.
  • Reevaluation of current rCBF parameter thresholds for early window stroke treatment is recommended.