Vandewalle Lieselotte, Konduri Praneeta R, Christensen Soren, Seners Pierre, Wouters Anke, Yuen Nicole, Mlynash Michael, Kemp Stephanie, Heit Jeremy J, Albers Gregory W, Demeestere Jelle, Lansberg Maarten G, Lemmens Robin
Neurology Department, University Hospitals of Leuven, Belgium (L.V., J.D., R.L.).
Division of Experimental Neurology, Department of Neurosciences, KU Leuven, Belgium (L.V., A.W., J.D., R.L.).
Stroke. 2025 Jun 25. doi: 10.1161/STROKEAHA.124.050317.
In acute ischemic stroke, infarcted tissue gradually becomes detectable on noncontrast computed tomography (NCCT) as a hypodensity representing vasogenic edema. We studied whether subtle NCCT density changes are also present in penumbral tissue.
This observational cohort study included patients with stroke with anterior circulation occlusions from the CRISP2 study (CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project 2) who were transferred from a primary to a comprehensive stroke center for consideration of endovascular thrombectomy. Patients received baseline NCCT and computed tomography perfusion at the referring hospital and magnetic resonance imaging at the receiving hospital. We created baseline relative NCCT images, which compare voxel density to the corresponding area in the contralateral hemisphere. We analyzed the relative density of rNCCT in the core and penumbra (based on computed tomography perfusion in referring hospitals). We also assessed the correlation between relative density and the degree of hypoperfusion in the penumbra, defined as the time-to-maximum of the tissue residue function. We studied the association between penumbral changes and functional outcomes on the full distribution of the modified Rankin Scale score at 90 days.
From the 314 patients, 162 met inclusion criteria with a median (interquartile range) age of 73 (61-83) years, penumbra volume of 78 (52-113) mL, and core volume of 0.6 (0-13.0) mL; 54% were men. The relative density was reduced by a median of 1.8% (<0.0001) in the penumbra and 3.3% in the core (<0.0001). Relative hypodensity in the penumbra was more profound with increasing hypoperfusion: 1.5% in regions with time-to-maximum of 6- to 8-s region, 1.8% in time-to-maximum of 8- to 10-s v, and 2.2% in time-to-maximum >10-s region (<0.0001). We identified a trend toward worse outcomes with more hypodense penumbra (odds ratio, 1.193 [95% CI, 0.996-1.430]).
In patients with anterior circulation acute ischemic stroke, we identified relative hypodensity in penumbral tissue on NCCT with potential clinical relevance on 90-day functional outcomes. The hypodensity was more pronounced with increasing hypoperfusion severity.
在急性缺血性卒中中，梗死组织在非增强计算机断层扫描（NCCT）上逐渐表现为低密度，代表血管源性水肿。我们研究了半暗带组织中是否也存在NCCT密度的细微变化。
这项观察性队列研究纳入了CRISP2研究（缺血性卒中再灌注预测的CT灌注项目2）中前循环闭塞性卒中患者，这些患者从初级卒中中心转入综合卒中中心以考虑进行血管内血栓切除术。患者在转诊医院接受了基线NCCT和计算机断层扫描灌注检查，并在接收医院接受了磁共振成像检查。我们创建了基线相对NCCT图像，将体素密度与对侧半球的相应区域进行比较。我们分析了核心区和半暗带（基于转诊医院的计算机断层扫描灌注）中rNCCT的相对密度。我们还评估了相对密度与半暗带低灌注程度之间的相关性，半暗带低灌注程度定义为组织残留函数的最大时间。我们研究了半暗带变化与90天时改良Rankin量表评分全部分布的功能结局之间的关联。
314例患者中，162例符合纳入标准，年龄中位数（四分位间距）为73（61 - 83）岁，半暗带体积为78（52 - 113）mL，核心区体积为0.6（0 - 13.0）mL；54%为男性。半暗带的相对密度中位数降低了1.8%（<0.0001），核心区降低了3.3%（<0.0001）。随着低灌注程度增加，半暗带的相对低密度更为明显：在最大时间为6至8秒的区域为1.5%，在最大时间为8至10秒的区域为1.8%，在最大时间>10秒的区域为2.2%（<0.0001）。我们发现半暗带密度越低，结局越差的趋势（优势比，1.193 [95% CI，0.996 - 1.430]）。
在前循环急性缺血性卒中患者中，我们在NCCT上发现半暗带组织存在相对低密度，这与90天功能结局具有潜在临床相关性。随着低灌注严重程度增加，低密度更为明显。
