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CT perfusion cerebral blood volume does not always predict infarct core in acute ischemic stroke

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Abstract

We investigated the practical clinical utility of the CT perfusion (CTP) cerebral blood volume (CBV) parameter for differentiating salvageable from non-salvageable tissue in acute ischemic stroke (AIS). Fifty-five patients with AIS were imaged within 6 h from onset using CTP. Admission CBV defect (CBVD) volume was outlined using previously established gray and white matter CBV thresholds for infarct core. Admission cerebral blood flow (CBF) hypoperfusion and CBF/CBV mismatch were visually evaluated. Truncation of the ischemic time–density curve (ITDC) and hypervolemia status at admission, recanalization at 24-h CT angiography, hemorrhagic transformation (HT) at 24 h and/or 7-day non-contrast CT (NCCT), final infarct volume as indicated by 3-month NCCT defect (NCCTD) and 3-month modified Rankin Score were determined. Patients with recanalization and no truncation had the highest correlation (R = 0.81) and regression slope (0.80) between CBVD and NCCTD. Regression slopes were close to zero for patients with admission hypervolemia with/without recanalization. Hypervolemia underestimated (p = 0.02), while recanalization and ITDC truncation overestimated (p = 0.03) the NCCTD. Among patients with confirmed recanalization at 24 h, 38 % patients had an admission CBF/CBV mismatch within normal appearing areas on respective NCCT. 83 % of these patients developed infarction in admission hypervolemic CBF/CBV mismatch tissue. A reduction in CBV is a valuable predictor of infarct core when the acquisition of ITDC data is complete and hypervolemia is absent within the tissue destined to infarct. Raised or normal CBV is not always indicative of salvageable tissue, contrary to the current definition of penumbra.

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Acknowledgments

This work has been supported by Italian National Health System- Research Program entitled “Nuove conoscenze e problematiche assistenziali nell’ictus cerebrale: un Programma Strategico di Ricerca e Sviluppo” ex art. 12-12bis/D.Lgs n. 502/92, PG/2007/0293184. The authors would also like to thank the Canadian Stroke Network and European Stroke Network, Canadian Institutes of Health Research, Ontario Research Fund and GE Healthcare for partial support of this study.

Conflict of interest

Ting-Yim Lee licenses CT Perfusion software to and receives funding from GE Healthcare.

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Authors and Affiliations

  1. Calgary Stroke Program, University of Calgary, Calgary, AB, Canada

    Christopher D. d’Esterre & Ting Yim Lee

  2. Imaging Program, Lawson Health Research Institute, London, ON, Canada

    Christopher D. d’Esterre & Ting Yim Lee

  3. Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy

    Gloria Roversi, Marina Padroni & Carmine Tamborino

  4. Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Andrea Bernardoni

  5. Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy

    Alessandro De Vito & Cristiano Azzini

  6. Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy

    Onofrio Marcello, Andrea Saletti, Stefano Ceruti & Enrico Fainardi

  7. Imaging Research Lab, Robarts Research Institute, London, ON, Canada

    Ting Yim Lee

Authors
  1. Christopher D. d’Esterre
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  2. Gloria Roversi
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  3. Marina Padroni
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  11. Ting Yim Lee
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Correspondence to Enrico Fainardi.

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d’Esterre, C.D., Roversi, G., Padroni, M. et al. CT perfusion cerebral blood volume does not always predict infarct core in acute ischemic stroke. Neurol Sci 36, 1777–1783 (2015). https://doi.org/10.1007/s10072-015-2244-8

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  • DOI: https://doi.org/10.1007/s10072-015-2244-8

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