CT perfusion for lesion-symptom mapping in large vessel occlusion ischemic stroke

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• CT perfusion (CTP) imaging identifies eloquent regions linked to poor outcomes in large vessel occlusion (LVO) ischemic stroke.
• Personalized selection for endovascular therapy (EVT) can be informed by CTP-defined hypoperfusion.
• Characterizing the relationship between CTP hypoperfusion and National Institutes of Health Stroke Scale (NIHSS) deficits is crucial.

Purpose of the Study:

• To characterize the relationship between CTP-defined hypoperfusion and NIHSS subitem deficits in LVO patients.
• To explore the potential of hypoperfusion-to-symptom mapping for guiding EVT decisions.

Main Methods:

• Included 171 patients with anterior circulation LVO, baseline CTP, and itemized NIHSS at presentation and 24 hours.
• Analyzed CTP using e-CTP, defining Tmax prolongation (>6s) and penumbra (Tmax-core).
• Performed voxel-lesion-symptom mapping using sparse canonical correlation analysis.

Main Results:

• Total NIHSS was predicted by hypoperfusion in the left frontal cortex and subcortical white matter tracts.
• Neurological recovery voxels were symmetrical and subcortical; limb deficits correlated with motor cortex regions.
• Language impairment correlated with left frontal cortex and superior temporal gyrus voxels; associations were diffuse for most NIHSS subitems.

Conclusions:

• Demonstrated feasibility of hypoperfusion-to-symptom mapping in LVO.
• Symptom-based mapping from presenting imaging can refine treatment decisions for specific neurological deficits.
• This approach may enhance personalized EVT selection for LVO stroke patients.