Ischemic core detection threshold of computed tomography perfusion (CTP) in acute stroke

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke requires rapid and accurate diagnosis to guide treatment.
• Assessing the ischemic core volume is critical for determining appropriate reperfusion therapies.

Purpose of the Study:

• To evaluate the accuracy of computed tomography perfusion (CTP) in detecting ischemic core volume.
• To compare CTP's detection accuracy against diffusion-weighted magnetic resonance imaging (DW-MRI) as the reference standard.

Main Methods:

• Retrospective analysis of patients with suspected acute ischemic stroke who underwent both CTP and DW-MRI.
• Measurement of ischemic core size using DW-MRI.
• Comparison of ischemic core volumes detected by CTP and DW-MRI.

Main Results:

• Only 26% of ischemic cores were detected by both CTP and DW-MRI; 74% were detected only by DW-MRI.
• Ischemic cores undetected by CTP were significantly smaller (median 0.6 mL) than those detected by CTP (median 14.2 mL).
• CTP failed to detect ischemic cores smaller than 5 mL, impacting treatment decisions for some patients.

Conclusions:

• CTP has limitations in detecting small ischemic core volumes (<5 mL).
• DW-MRI is essential for accurate assessment of small ischemic brain lesions.
• Accurate imaging is vital for guiding treatment decisions in acute ischemic stroke.