Otgonbaatar Chuluunbaatar, Lee Ji Ye, Jung Keun-Hwa, Hwang Inpyeong, Yoo Roh-Eul, Kang Koung Mi, Yun Tae Jin, Choi Seung Hong, Kim Ji-Hoon, Sohn Chul-Ho
Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Department of Radiology, Seoul National University Hospital, #101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107062. doi: 10.1016/j.jstrokecerebrovasdis.2023.107062. Epub 2023 Mar 20.
Although computed tomography perfusion (CTP) is used to select and guide decision-making processes in patients with acute ischemic stroke, there is no clear standardization of the optimal threshold to predict ischemic core volume accurately. The infarct core volume with a relative cerebral blood flow(rCBF) threshold of < 30% is commonly used. We aimed to assess the volumetric agreement of the infarct core volume with different CTP parameters and thresholds using CTP software (RAPID, VITREA) and the infarct volume on diffusion-weighted imaging (DWI), with a short interval time (within 60 min) between CTP and follow-up DWI.
This retrospective study included 42 acute ischemic stroke patients with occlusion of the large artery in the anterior circulation between April 2017-November 2020. RAPID identified infarct core as tissue rCBF < 20-38%. VITREA defined the infarct core as cerebral blood volume (CBV) < 26-56%. Olea Sphere was used to measure infarct core volume on DWI. The CTP-infarct core volume with different thresholds of perfusion parameters (CBF threshold vs CBV threshold) were compared with DWI-infarct core volumes.
The median time between CTP and DWI was 37.5min. The commonly used threshold of CBV< 41% (4.3 mL) resulted in lower median infarct core volume difference compared to the commonly used thresholds of rCBF < 30% (8.2mL). On the other hand, the optimal thresholds of CBV < 26% (-1.0mL; 95% CI, -53.9 to 58.1 mL; 0.945) resulted in the lowest median infarct core volume difference, narrowest limits of agreement, and largest interclass correlation coefficient compared with the optimal thresholds of rCBF < 38% (4.9 mL; 95% CI, -36.4 to 62.9 mL; 0.939).
Our study found that the both optimal and commonly used thresholds of CBV provided a more accurate prediction of the infarct core volume in patients with AIS than rCBF.
尽管计算机断层扫描灌注成像（CTP）用于急性缺血性脑卒中患者的筛选及指导决策过程，但对于准确预测缺血核心体积的最佳阈值尚无明确的标准化。相对脑血流量（rCBF）阈值<30%的梗死核心体积是常用的。我们旨在使用CTP软件（RAPID、VITREA）评估不同CTP参数和阈值下梗死核心体积与扩散加权成像（DWI）上梗死体积的体积一致性，且CTP与随访DWI之间的间隔时间较短（60分钟内）。
这项回顾性研究纳入了2017年4月至2020年11月期间42例前循环大动脉闭塞的急性缺血性脑卒中患者。RAPID将梗死核心识别为组织rCBF<20%-38%。VITREA将梗死核心定义为脑血容量（CBV）<26%-56%。使用Olea Sphere测量DWI上的梗死核心体积。将不同灌注参数阈值（CBF阈值与CBV阈值）下的CTP梗死核心体积与DWI梗死核心体积进行比较。
CTP与DWI之间的中位时间为37.5分钟。与常用的rCBF<30%（8.2mL）阈值相比，常用的CBV<41%（4.3mL）阈值导致梗死核心体积的中位差异更低。另一方面，与rCBF<38%（4.9mL；95%CI，-36.4至62.9mL；0.939）的最佳阈值相比，CBV<26%（-1.0mL；95%CI，-53.9至58.1mL；0.945）的最佳阈值导致梗死核心体积的中位差异最低、一致性界限最窄且组间相关系数最大。
我们的研究发现，CBV的最佳阈值和常用阈值在急性缺血性脑卒中患者中对梗死核心体积的预测比rCBF更准确。
