Kim Nakhoon, Ryu Wi-Sun, Ha Sue Young, Kim Jun Yup, Kang Jihoon, Baik Sung Hyun, Jung Cheolkyu, Han Moon-Ku, Bae Hee-Joon, Lin Longting, Parsons Mark, Kim Beom Joon
Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
Artificial Intelligence Research Center, JLK, Seoul, South Korea.
Ann Neurol. 2025 May;97(5):919-929. doi: 10.1002/ana.27169. Epub 2024 Dec 26.
Computed tomography perfusion (CTP) imaging is crucial in quantifying cerebral blood flow (CBF) and thereby making an endovascular treatment (EVT) after large vessel occlusion. However, CTP is prone to overestimating the ischemic core. We sought to delineate the optimal regional CBF (rCBF) thresholds of pre-EVT CTP.
We collected acute ischemic stroke patients due to large vessel occlusion who achieved successful recanalization with baseline CTP, immediate post-EVT diffusion-weighted image (DWI) within 3 hours, and delayed post-EVT DWI between 24 and 196 hours. Core volumes estimated by CTP at various rCBF thresholds were validated against immediate and delayed DWI lesion volumes.
A total of 175 acute large vessel occlusion patients were included. Baseline CTP was taken in a median of 24 minutes (interquartile range [IQR] 21-31 minutes) after arrival; after the CTP, groin puncture in a median of 37 minutes (IQR 28-52 minutes), immediate post-EVT DWI scans in a median of 1.6 hours (IQR 0.8-2.1 hours), and delayed DWI scans in a median of 89 hours (IQR 69-106 hours). The correlations between the rCBF thresholds were the best at rCBF <22% for immediate DWI (0.64; 95% CI 0.55-0.73) and at rCBF <30% for delayed DWI (0.69; 95% CI 0.61-0.76). The interval between CTP and recanalization was inversely correlated with the overestimation of ischemic core volume compared with the subsequent DWI.
Optimal rCBF thresholds for estimating ischemic core using CTP depend significantly on the timing of DWI post-EVT and CTP to recanalization delay. The optimal rCBF thresholds for ischemic core estimation may vary depending on the clinical setting. ANN NEUROL 2025;97:919-929.
计算机断层扫描灌注（CTP）成像在量化脑血流量（CBF）从而指导大血管闭塞后的血管内治疗（EVT）方面至关重要。然而，CTP容易高估缺血核心区。我们试图确定EVT前CTP的最佳局部脑血流量（rCBF）阈值。
我们收集了因大血管闭塞导致急性缺血性卒中且成功再通的患者，这些患者有基线CTP、EVT后3小时内的即刻扩散加权成像（DWI）以及EVT后24至196小时的延迟DWI。在不同rCBF阈值下通过CTP估计的核心体积与即刻和延迟DWI病变体积进行验证。
共纳入175例急性大血管闭塞患者。基线CTP在到达后中位数为24分钟（四分位间距[IQR]21 - 31分钟）进行；CTP后，腹股沟穿刺中位数为37分钟（IQR 28 - 52分钟），EVT后即刻DWI扫描中位数为1.6小时（IQR 0.8 - 2.1小时），延迟DWI扫描中位数为89小时（IQR 69 - 106小时）。对于即刻DWI，rCBF <22%时rCBF阈值之间的相关性最佳（0.64；95%CI 0.55 - 0.73），对于延迟DWI，rCBF <30%时相关性最佳（0.69；95%CI 0.61 - 0.76）。与后续DWI相比，CTP与再通之间的间隔与缺血核心体积的高估呈负相关。
使用CTP估计缺血核心区的最佳rCBF阈值很大程度上取决于EVT后DWI的时间以及CTP至再通的延迟。缺血核心区估计的最佳rCBF阈值可能因临床情况而异。《神经病学年鉴》2025年；97：919 - 929。
