Defining Large Core Infarction: Comparing the Accuracy of Non-Contrast CT ASPECTS Versus CT Perfusion Core Volume.

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) requires timely intervention.
• Endovascular therapy (EVT) is a crucial treatment for LVO-AIS.
• Accurate assessment of infarct core size is vital for treatment decisions and outcome prediction.

Purpose of the Study:

• To evaluate the agreement and performance of non-contrast head-computerized tomography (NCHCT) and CT-perfusion (CTP) in identifying large core infarcts in LVO-AIS patients undergoing EVT.
• To compare NCHCT and CTP against MRI-defined final infarct volume (FIV) as a reference standard.
• To assess the predictive ability of NCHCT and CTP for 90-day functional independence.

Main Methods:

• A prospective multicenter registry identified LVO-AIS patients who underwent EVT.
• Final infarct volume (FIV) was determined using diffusion-weighted imaging MRI at 24-48 hours post-EVT.
• Large core infarct was defined by FIV thresholds (50, 70, 100 mL); agreement was assessed using kappa statistics, and classification accuracy using AUC-ROC.

Main Results:

• Among 241 EVT-treated patients, NCHCT and CTP showed slight agreement (κ = 0.192) in identifying large core infarcts.
• Both modalities had weak-to-acceptable discrimination (AUC-ROC: 0.61-0.72) for large core infarcts compared to MRI-FIV.
• NCHCT and CTP demonstrated limited predictive ability for 90-day functional independence (AUC-ROC: 0.63-0.65).

Conclusions:

• NCHCT and CTP have limited agreement in classifying infarct core size in LVO-AIS patients undergoing EVT.
• Neither imaging technique is effective in predicting final infarct volume or 90-day functional outcomes.
• Further research may be needed to identify optimal imaging biomarkers for guiding EVT in AIS.