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Updated: Apr 29, 2026

Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
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Same-territory chronic infarcts are common in intracranial atherosclerosis and are associated with future recurrence

Davor Pavlin Premrl1, Benjamin Churilov2, Vincent Thijs3,4

  • 1Neurology, Austin Health, Heidelberg, Victoria, Australia.

BMJ Neurology Open
|April 28, 2026
PubMed

Insights

Chronic same-territory infarcts are common in patients with intracranial atherosclerotic disease (ICAD). These infarcts better predict future ischemic events than severe stenosis or hypoperfusion.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Intracranial atherosclerotic disease (ICAD) carries a high risk of recurrent symptomatic events.
  • Understanding predictors of recurrence is crucial for patient management.

Purpose of the Study:

  • To determine the prevalence of same-territory chronic infarcts in symptomatic ICAD patients.
  • To evaluate the ability of chronic infarcts to predict future same-territory ischemic events.

Main Methods:

  • Retrospective analysis of prospectively collected data from two Australian stroke centers.
  • 135 symptomatic ICAD patients were followed for 12 months for recurrent ischemia.
  • Prognostic characteristics including chronic infarcts, >70% stenosis, and CT-perfusion hypoperfusion were analyzed for predictive ability using ROC analysis and BIC.

Main Results:

  • 21% of patients had chronic same-territory infarcts.
  • Recurrent events occurred in 31% of patients with chronic infarcts versus 10% without (OR 3.9, p=0.008).
  • Chronic infarcts demonstrated superior model fit (AUC 0.64) compared to >70% stenosis (AUC 0.58) and CT-perfusion hypoperfusion, outperforming combinations of these factors.

Conclusions:

  • Chronic same-territory infarcts are prevalent in symptomatic ICAD.
  • Chronic infarcts are significant predictors of future same-territory ischemic cerebrovascular events.
  • Chronic infarcts offer better prognostic discrimination than severe stenosis or hypoperfusion on CTP.
Abstract

Keywords:
STROKE

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