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Optimal Cerebral Blood Flow Thresholds for Ischemic Core Estimation Using Computed Tomography Perfusion and

Nakhoon Kim1, Wi-Sun Ryu2, Sue Young Ha2,3

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Optimizing computed tomography perfusion (CTP) thresholds for large vessel occlusion stroke is key. Optimal regional cerebral blood flow (rCBF) thresholds vary based on imaging timing post-endovascular treatment (EVT).

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Computed tomography perfusion (CTP) is vital for assessing cerebral blood flow (CBF) in large vessel occlusion (LVO) stroke, guiding endovascular treatment (EVT).
  • CTP imaging can overestimate the ischemic core volume, potentially impacting treatment decisions.
  • Establishing precise regional cerebral blood flow (rCBF) thresholds is crucial for accurate CTP interpretation.

Purpose of the Study:

  • To determine the optimal pre-EVT CTP rCBF thresholds for accurately estimating ischemic core volume in LVO stroke.
  • To validate CTP-derived core volumes against immediate and delayed post-EVT diffusion-weighted imaging (DWI) lesion volumes.

Main Methods:

  • Retrospective analysis of 175 acute LVO stroke patients who underwent successful EVT.
  • Collected baseline CTP, immediate (<3 hours), and delayed (24-196 hours) post-EVT DWI scans.
  • Compared CTP-estimated core volumes at various rCBF thresholds with DWI lesion volumes.

Main Results:

  • The strongest correlations between CTP-estimated core and DWI lesions were observed at rCBF <22% for immediate DWI and rCBF <30% for delayed DWI.
  • The time interval between CTP and recanalization was inversely correlated with ischemic core overestimation.
  • Optimal rCBF thresholds demonstrated moderate to good correlation with DWI lesion volumes.

Conclusions:

  • Optimal rCBF thresholds for ischemic core estimation using CTP are dependent on the timing of post-EVT DWI and the delay to recanalization.
  • These thresholds may need to be adjusted based on specific clinical scenarios and imaging protocols.
  • Accurate ischemic core assessment is critical for optimizing EVT in LVO stroke.