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Arterial Input Function Dispersal on Acute Brain CT Perfusion Scan in Patients With Acute Stroke and an Intracardiac
Carlos Garcia-Esperon1,2,3, Alexander Berry-Noronha4, Angelo Di Bartolo4
1Department of Neurology, John Hunter Hospital, Newcastle, Australia.
Insights
Prolonged arterial input function (AIF) dispersal on CT scans indicates a higher likelihood of intracardiac thrombus in stroke patients. This finding also predicts a poorer 3-month outcome, aiding in risk stratification.
Area of Science:
- Cardiovascular Imaging
- Neurology
- Radiology
Background:
- Hyperacute cardiac CT effectively identifies intracardiac thrombus but involves higher costs and radiation exposure.
- Identifying patients with a low pretest probability of thrombus can rationalize CT utilization.
- Arterial input function (AIF) dispersal, derived from brain perfusion CT, correlates with left ventricular ejection fraction.
Purpose of the Study:
- To investigate the association between AIF dispersal and the presence of intracardiac thrombus.
- To determine if AIF dispersal predicts 3-month outcomes after ischemic stroke or TIA.
Main Methods:
- Retrospective analysis of 1,136 patients with ischemic stroke or TIA.
- Data collected from three comprehensive stroke centers between September 2019 and August 2023.
- Analysis of AIF dispersal duration from brain perfusion CT scans.
Main Results:
- Intracardiac thrombus was identified in 5.2% of patients.
- Longer AIF dispersal duration was associated with the presence of intracardiac thrombus (OR 1.09).
- An AIF dispersal cutoff of ≥33 seconds optimally identified intracardiac thrombus (OR 6.66) and predicted poor 3-month outcomes (OR 1.03).
Conclusions:
- Prolonged AIF dispersal is a novel indicator for intracardiac thrombus in stroke patients.
- AIF dispersal duration predicts poor 3-month outcomes post-stroke.
- These findings have significant clinical implications for stroke patient management and risk assessment.
Background And Objectives:
Hyperacute cardiac CT has shown greater yield for intracardiac thrombus identification compared with transthoracic echocardiography. However, routine use comes with higher cost and additional contrast and radiation exposure. Pretest identification of patients with low probability of thrombus would enable rationalization of its use. Arterial input function (AIF) curves are generated automatically as part of brain perfusion CT. Time from scan onset to the end of AIF (AIF dispersal) is correlated with left ventricular ejection fraction. We hypothesized that there would be an association between AIF dispersal and (1) presence of intracardiac thrombus and (2) 3-month outcome after ischemic stroke/TIA.
Methods:
This is a retrospective analysis of prospectively collected patients with a final diagnosis of ischemic stroke or TIA presenting at 3 comprehensive stroke centers between September 2019 and August 2023.
Results:
A total of 1,136 patients were included, and the median age was 74 years (interquartile range, IQR [62-81]). The median baseline National Institutes of Health Stroke Scale score was 6 (IQR [3-14]). Intracardiac thrombus was present in 59 patients (5.2%) on hyperacute cardiac CT. The median AIF dispersal was 27 (IQR [22-33]) seconds. Longer AIF dispersal duration was associated with presence of intracardiac thrombus, with an odds ratio (OR) of 1.09 (95% CI 1.05-1.13). AIF dispersal ≥33 seconds was the optimal cutoff point for presence of intracardiac thrombus with a positive association, with OR 6.66 (3.26-13.59). AIF dispersal as a continuous variable was associated with increased risk of poor outcome (modified Rankin Scale scores 5-6) 3 months after stroke in multivariate analysis (OR 1.03 [95% CI 1.00-1.05]). AIF dispersal ≥33 seconds was also associated with worse outcome after stroke in univariate analysis.
Discussion:
Prolonged AIF dispersal identifies patients with stroke more likely to have (1) an intracardiac thrombus at the time of presentation and (2) poor outcome 3 months after stroke. These novel findings have significant clinical implications.
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