Accuracy of "At Risk" Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions. Issue 3 (16th January 2019)

• Record Type: Journal Article
• Authors: Lee, Songmi; Yoo, Albert J.; Marquering, Henk A.; Berkhemer, Olvert A.; Majoie, Charles B.; Dippel, Diederik W.J.; Sheth, Sunil A.
• Is Part Of: Journal of neuroimaging. Volume 29:Issue 3(2019)
• Page Start: 371
• Page End: 375
• Publication Date: 2019-01-16
• Subjects: CT Perfusion -- "at risk" tissue -- stroke -- endovascular treatment; Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/jon.12595
• Languages: English
• ISSNs: 1051-2284

Abstract

ABSTRACT: BACKGROUND AND PURPOSE: The validity of CT perfusion (CTP) predictions of expected infarction volume ("at risk" tissue) without rapid recanalization remains poorly characterized. METHODS: From the MR CLEAN trial, we included patients who underwent CTP without successful recanalization. "At risk" volume was defined as T max > 6 seconds and ischemic core as relative CBF < 30 (Olea Sphere). Coprimary outcomes were follow‐up infarct volume (FIV) on CT at 1‐5 days and 90‐day mRS. Data are presented as median [IQR] or OR [95% CI] unless otherwise specified. RESULTS: Among 37 patients who met criteria, 14 (38%) were women, median age was 61 years [52‐69], NIHSS was 19 [15‐21], ASPECTS was 8 [7‐9], and onset to imaging was 160 minutes [39‐200]. Occlusion location was M1 for 22 (59%), ICA‐T in 10 (27%), and M2 in 4 (11%). In univariable analysis, "at risk" volume correlated poorly with FIV ( r = .06, P = .77). Among patients with predicted "at risk" volume < 100 mL, 36% had FIV > 200 mL. In adjusted linear regression, NIHSS but not "at risk" volume was associated with FIV (Coef 12, P = .045; Coef –.15, P = .8). In adjusted logistic regression, NIHSS but not "at risk" volume was associated with mRS 0‐2 at 90 days (OR .7 [.5‐.99]; OR 1.0 [.99‐1.04]). CONCLUSION: Predictions of "at‐risk" tissue using CTP may underestimate the natural history of infarction from acute large vessel occlusions. NIHSS may perform better as a predictor of clinical outcomes in patients without rapid recanalization.