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Accuracy of computed tomography perfusion-defined ischemic core and follow-up infarction after basilar artery
Pengjun Chen1, Xia Li1, Yechao Huang1
1Zhejiang Key Laboratory of Imaging and Interventional Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China.
Insights
Identifying the ischemic core in basilar artery occlusion (BAO) is crucial for stroke treatment. A cerebral blood flow (CBF) threshold of less than 10 mL/100g/min accurately identifies the ischemic core in BAO patients post-thrombectomy.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Accurate identification of the ischemic core in computed tomography (CT) perfusion is vital for prognostic prediction and treatment decisions in basilar artery occlusion (BAO).
- Current methods for defining the ischemic core in BAO present challenges in precise identification.
Purpose of the Study:
- To define the optimal threshold for identifying the ischemic core in patients with BAO using CT perfusion.
- To assess the agreement in lesion extent and spatial distribution of the ischemic core using Syngo.via software.
Main Methods:
- Retrospective analysis of 91 patients with BAO who underwent successful endovascular thrombectomy.
- Ischemic core estimation using thresholds for cerebral blood flow (CBF) < 10 or 15 mL/100g/min, cerebral blood volume (CBV) < 1.2 mL/100mL, and time to maximum (Tmax) > 10s.
- Assessment of infarction extent using the Posterior Circulation Alberta Stroke Program Early CT Score and statistical analysis including intraclass correlation coefficient (ICC) and receiver operating characteristic (ROC) analyses.
Main Results:
- The CBF < 10 mL/100g/min threshold showed good agreement with follow-up infarction extent (ICC: 0.81), with minimal overestimation or underestimation.
- This CBF threshold demonstrated the best performance in detecting midbrain, pontine, and cerebellar infarction, with areas under the curve (AUC) ranging from 0.79 to 0.90.
- The CBF < 15 mL/100g/min and CBV < 1.2 mL/100mL thresholds showed less optimal agreement and performance.
Conclusions:
- A CBF threshold of < 10 mL/100g/min is the optimal criterion for identifying the ischemic core in BAO patients following successful recanalization.
- This CBF threshold serves as a reliable imaging biomarker for predicting tissue outcomes and guiding treatment decisions in BAO.
- Further validation of this threshold can improve patient management in acute basilar artery stroke.
Purpose:
Accurate identification of computed tomography (CT) perfusion ischemic core in patients with basilar artery occlusion (BAO) on admission remains challenging despite its critical role in prognostic prediction and treatment decision-making. We aimed to define the optimal threshold for identifying the ischemic core by assessing agreement in lesion extent and spatial distribution using Syngo.via.
Methods:
We retrospectively analyzed 91 patients with BAO who achieved successful recanalization after endovascular thrombectomy at our center. The ischemic core was estimated using the following thresholds: cerebral blood flow (CBF) < 10 or 15 mL/100 g/min by Syngo.via, cerebral blood volume < 1.2 mL/100 mL by Syngo.via, and time to maximum > 10 s by RAPID. The Posterior Circulation Alberta Stroke Program Early CT Score was used to assess the extent of the infarction. Statistical analyses included the intraclass correlation coefficient (ICC) and receiver operating characteristic analyses.
Results:
The CBF < 10 mL/100 g/min threshold demonstrated good agreement in extent with follow-up infarction (ICC: 0.81 [95% confidence intervals 0.72-0.87]), with overestimation or underestimation being the most uncommon (n = 9). For the detection of midbrain, pontine, and cerebellar infarction, this threshold yielded the best performance with the area under the curve ranging from 0.79 (midbrain, 0.66-0.93; p < 0.001) to 0.90 (pons, 0.83-0.98; p < 0.001).
Conclusion:
In patients with BAO after successful recanalization, the optimal threshold for the ischemic core was a CBF < 10 mL/100 g/min. This threshold may serve as a reliable imaging biomarker, aiding in the prediction of tissue outcomes and treatment decision-making.
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