Kremenova Karin, Holesta Michal, Peisker Tomas, Girsa David, Weichet Jiri, Lukavsky Jiří, Malikova Hana
Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep.
Department of Neurology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep.
Quant Imaging Med Surg. 2020 Oct;10(10):1908-1916. doi: 10.21037/qims-20-555.
The initial core infarct volume predicts treatment outcome in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). According to the literature, CT perfusion (CTP) is able to evaluate cerebral parenchymal viability and assess the initial core in AIS. We prospectively studied whether limited-coverage CTP with automated core calculation correlates with the final infarct volume on follow-up non-enhanced CT (NECT) in patients successfully treated by mechanical thrombectomy.
We enrolled 31 stroke patients (20 women aged 74.4±12.9 years and 11 men aged 66±15.4 years; median initial NIHSS score 15.5) with occlusion of the medial cerebral artery and/or the internal carotid artery that were treated by successful mechanical thrombectomy. CTP performed in a 38.6 mm slab at the level of basal ganglia was included in the CT stroke protocol, but was not used to determine indication for mechanical thrombectomy. The infarction core volume based on CTP was automatically calculated using dedicated software with a threshold defined as cerebral blood flow <30% of the value in the contralateral healthy hemisphere. The final infarction volume was measured on 24-hour follow-up NECT in the same slab with respect to CTP. Pearson and Spearman correlation coefficients and robust linear regression were used for comparison of both volumes, P values <0.05 were considered as statistically significant.
The median time from stroke onset to CT was 77 minutes (range, 31-284 minutes), and the median time from CT to vessel recanalization was 95 minutes (range, 55-215 minutes). The mean CTP-calculated core infarct volume was 24.3±19.2 mL (median 19 mL, range 1-79 mL), while the mean final infarct volume was 21.5±39.5 mL (median 8 mL; range 0-210 mL). Only a weak relationship was found between the CTP-calculated core and final infarct volume [Pr =0.32, P=0.078; rho =0.40, P=0.028]. Regression analysis showed CTP significantly overestimated lower volumes.
In our prospective study, the infarction core calculated using limited-coverage CTP only weakly correlated with the final infarction volume measured on 24-hour follow-up NECT; moreover, CTP significantly overestimated lower volumes. Our results do not support the use of limited-coverage CTP for guiding treatment recommendations in patients with AIS.
初始核心梗死体积可预测大动脉闭塞（LVO）所致急性缺血性卒中（AIS）患者的治疗结局。据文献报道，CT灌注（CTP）能够评估脑实质的存活能力并评估AIS的初始梗死核心。我们前瞻性研究了在成功接受机械取栓治疗的患者中，采用自动核心计算的有限覆盖范围CTP与随访时非增强CT（NECT）上的最终梗死体积是否相关。
我们纳入了31例大脑中动脉和/或颈内动脉闭塞且成功接受机械取栓治疗的卒中患者（20名女性，年龄74.4±12.9岁；11名男性，年龄66±15.4岁；初始NIHSS评分中位数为15.5）。在基底节水平38.6mm厚层进行的CTP被纳入CT卒中检查方案，但未用于确定机械取栓的指征。使用专用软件基于CTP自动计算梗死核心体积，阈值定义为脑血流量<对侧健康半球值的30%。在与CTP相同的厚层上，于24小时随访NECT时测量最终梗死体积。使用Pearson和Spearman相关系数以及稳健线性回归来比较两个体积，P值<0.05被认为具有统计学意义。
从卒中发作到CT的中位时间为77分钟（范围31 - 284分钟），从CT到血管再通的中位时间为95分钟（范围55 - 215分钟）。CTP计算的平均核心梗死体积为24.3±19.2mL（中位数19mL，范围1 - 79mL），而平均最终梗死体积为21.5±39.5mL（中位数8mL；范围0 - 210mL）。在CTP计算的核心梗死体积与最终梗死体积之间仅发现弱相关性[Pr =0.32，P =0.078；rho =0.40，P =0.028]。回归分析显示CTP显著高估了较小的体积。
在我们的前瞻性研究中，使用有限覆盖范围CTP计算的梗死核心与24小时随访NECT测量的最终梗死体积仅存在弱相关性；此外，CTP显著高估了较小的体积。我们的结果不支持在AIS患者中使用有限覆盖范围CTP来指导治疗建议。
