Related Experiment Video
Updated: Feb 27, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Defining Large Core Infarction: Comparing the Accuracy of Non-Contrast CT ASPECTS Versus CT Perfusion Core Volume
Ngoc Mai Le1, Joseph Samaha1, Ananya S Iyyangar1
1Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA.
Background And Purpose:
We evaluated agreement and performance of non-contrast head-computerized tomography (NCHCT) and CT-perfusion (CTP) in identifying large core infarct in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing endovascular therapy (EVT), using MRI as reference.
Methods:
From our prospective multicenter registry, we identified patients with LVO-AIS due to internal carotid artery or middle cerebral artery M1occlusions who underwent EVT between 2017 and 2024. Final infarct volume (FIV) was defined using 24-48 h post-EVT diffusion-weighted imaging magnetic resonance imaging (MRI-FIV). To limit infarct growth bias, only patients with CTP-to-EVT start time <3 h were included. Large core infarct was defined at FIV thresholds: 50, 70, and 100 mL. The primary outcome was agreement between NCHCT and CTP in identifying large core infarct using kappa-statistics. Large core was considered if NCHCT-ASPECTS<6 or rCBF<30% volume>70 mL on CTP (RAPID/Viz.AI). Secondary outcomes included classification accuracy of each modality relative to MRI-FIV using the area under the receiver operating characteristic curve (AUC-ROC). Sensitivity analyses were performed in subgroups with TICI 2c-3 and cases processed by RAPID.
Results:
Among 241 EVT-treated LVO-AIS patients, median NIHSS was 15 [IQR: 10-20], MRI-FIV 13.8 Ml [IQR: 5-41.0], ASPECTS 8 [IQR: 7-10], and CTP-predicted core 8 mL [IQR: 0-31.0]. CTP and NCHCT showed slight agreement in identifying large core (κ = 0.192) and weak-to-acceptable discrimination for identifying large core infarcts (AUC-ROC: 0.61-0.72 across MRI-FIV thresholds). Both modalities showed limited predictive ability for 90-day functional independence (AUC-ROC: 0.63-0.65). Similar findings were observed in sensitivity analyses.
Conclusions:
Among LVO-AIS EVT-treated patients, NCHCT and CTP demonstrated slight agreement in classifying small versus large core, and neither technique was effective at predicting FIV or clinical outcomes.
More Related Videos
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:19Imaging Studies VII: Vascular Imaging
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...