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Computed Tomography Perfusion Core Infarct Measurement Compared to Diffusion-Weighted Magnetic Resonance Imaging in Patients with Revascularization of Anterior Circulation, Large Artery Occlusion Ischemic Stroke

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Abstract

Relative cerebral blood flow (CBF) < 30% has been identified as a predictor of infarct core on computed tomography perfusion (CTP). We investigated the relationship between CTP-predicted infarct core and diffusion-weighted imaging magnetic resonance imaging (DWI MRI). We conducted a retrospective analysis comparing infarct core (CBF < 30%; RAPID iSchemaView) and post-revascularization DWI MRI (ADC < 620 cc; RAPID iSchemaView) in patients with internal carotid artery (ICA) or proximal middle cerebral artery (MCA) stroke between November 2016 and May 2019. Included subjects had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or better and presented within 24 h of last known well (LKW) time. Two hundred one cases were identified. Mean duration from LKW time to CTP and MRI was 4.3 and 28.6 h, respectively. Median ischemic core volume was 8 cc, and median MRI infarct volume was 17 cc. CTP core volume showed fair correlation with MRI infarct volume (r = 0.294, p < 0.0001). There was a stronger association between CBF < 30% and DWI MRI in subjects presenting beyond 6 h (r = 0.359, p = 0.011). In a multivariate analysis, greater volumetric difference was associated with younger age (p = 0.001), longer duration from LKW time to revascularization time (p < 0.020), and longer CTP to revascularization time (p < 0.0001). Reduced relative CBF < 30% is a fair measure of infarct size within 24 h of anterior circulation, large artery occlusion (LAO) stroke when adequate reperfusion is achieved.

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Data Availability

All data were de-identified and gathered in a code stroke registry for the healthcare system. All data relevant to the study are included in the article. Any additional data are available upon reasonable request. Please address any requests to: Jeremy.Rhoten@atriumhealth.org or Rahul.Karamchandani@gmail.com.

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Authors and Affiliations

  1. Department of Neurology, Atrium Health, Charlotte, NC, United States

    Rahul R. Karamchandani & Jeffrey Bodle

  2. Atrium Health, Charlotte, NC, USA

    Jeremy B. Rhoten

  3. Information and Analytics Services, Atrium Health, Charlotte, NC, USA

    Dale Strong & Brenda Chang

  4. Charlotte Radiology, Atrium Health, Charlotte, NC, USA

    Gary Defilipp, Jonathan D. Clemente, Eric Wang, Ross Bellavia & Andrew U. Hines

  5. Carolina Neurosurgery and Spine Associates, Atrium Health, Charlotte, NC, USA

    Joe Bernard & William Stetler

  6. Department of Emergency Medicine, Atrium Health, Charlotte, NC, USA

    Andrew W. Asimos

Authors
  1. Rahul R. Karamchandani
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Contributions

Conceptualization: Rahul R. Karamchandani, Jeremy B. Rhoten, Dale Strong, Jeffrey Bodle, Andrew U. Hines, and Andrew W. Asimos. Methodology: Rahul R. Karamchandani, Jeremy B. Rhoten, and Dale Strong. Data curation: Dale Strong and Jeremy B. Rhoten. Formal analysis: Dale Strong and Brenda Chang; Writing—original draft: Rahul R. Karamchandani. Writing—review and editing: Rahul R. Karamchandani, Jeremy B. Rhoten, Dale Strong, Brenda Chang, Gary Defilipp, Joe Bernard, Jonathan D. Clemente, Eric Wang, Ross Bellavia, William Stetler, Jeffrey Bodle, Andrew U. Hines, and Andrew W. Asimos. Supervision: Andrew W. Asimos.

Corresponding author

Correspondence to Rahul R. Karamchandani.

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Conflict of Interest

Dr. Jonathan Clemente serves as a Clinical Trainer and Member of the Medical Advisory Board of IschemaView (Redmon, CA). Dr. Rahul R. Karamchandani, Jeremy B. Rhoten, Dale Strong, Brenda Chang, Dr. Gary Defilipp, Dr. Joe Bernard, Dr. Eric Wang, Dr. Ross Bellavia, Dr. William Stetler, Dr. Jeffrey Bodle, Dr. Andrew U. Hines, and Dr. Andrew W. Asimos declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Due to the retrospective study design and use of de-identified data, the requirement for informed consent was waived by the IRB.

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Karamchandani, R.R., Rhoten, J.B., Strong, D. et al. Computed Tomography Perfusion Core Infarct Measurement Compared to Diffusion-Weighted Magnetic Resonance Imaging in Patients with Revascularization of Anterior Circulation, Large Artery Occlusion Ischemic Stroke. SN Compr. Clin. Med. 2, 2730–2737 (2020). https://doi.org/10.1007/s42399-020-00651-z

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