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Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
CT Imaging Predictors of Early Neurologic Deterioration and 90-Day Outcomes in Thrombolysed Acute Ischemic Stroke: A
Yunjian Li1, Xianxian Zhang2, Tingting Wang1
1Department of Radiology, The Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital, Yancheng, China.
Objectives:
This study aimed to evaluate the association between multimodal CT imaging parameters and Early Neurologic Deterioration (END) and 90-day functional outcomes in patients with acute anterior-circulation ischemic stroke treated with intravenous thrombolysis.
Methods:
In this retrospective single-center study, patients with anterior-circulation ischemic stroke who underwent multimodal CT imaging, including noncontrast CT, CT angiography, and CT perfusion prior to thrombolysis, were analyzed. Imaging parameters, including ASPECTS, regional leptomeningeal collateral (rLMC) score, infarct core, perfusion lesion, and ischemic penumbra volumes, were quantified using RAPID software. Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were applied to identify independent predictors of END and of long-term functional outcome, as measured by the 90-day modified Rankin Scale.
Results:
A total of 131 patients were included, of whom 16% developed END. Lower rLMC scores and larger infarct core, perfusion lesion, and ischemic penumbra volumes were significantly associated with a higher risk of END and unfavorable 90-day outcomes. Perfusion lesion volume showed the strongest discrimination for predicting END, while the rLMC score demonstrated the highest predictive value for a favorable long-term functional outcome. ROC-derived thresholds exhibited only moderate accuracy and are considered exploratory.
Discussion:
These findings highlight the prognostic relevance of collateral status and CT-derived perfusion parameters in identifying patients at higher risk of neurologic worsening and long-term disability after thrombolysis.
Conclusion:
Multimodal CT imaging parameters, particularly rLMC score and perfusion-based tissue volumes, are associated with END and 90-day outcomes following thrombolysis. Further multicenter validation is necessary before clinical implementation.
