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Early CT perfusion mismatch in acute stroke is not time-dependent but relies on collateralization grade

  • Diagnostic Neuroradiology
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Abstract

Introduction

Factors that determine the extent of the penumbra in the initial diagnostic workup using whole brain CT Perfusion (WB-CTP) remain unclear. The purpose of the current study was to determine a possible dependency of the initial mismatch size between cerebral blood flow (CBF) and cerebral blood volume (CBV) from time after symptom onset, leptomeningeal collateralization, and occlusion localization in acute middle cerebral artery (MCA) infarctions.

Methods

Out of an existing cohort of 992 consecutive patients receiving multiparametric CT scans including WB-CTP due to suspected stroke, we included patients who had (1) a witnessed time of symptom onset, (2) an infarction of the MCA territory as documented by follow-up imaging, and (3) an initial CBF volume of >10 ml. CBF and CBV lesion sizes, collateralization grade, and the site of occlusion were determined.

Results

We included 103 patients. Univariate analysis showed that time from symptom onset (168 +/− 91.2 min) did not correlate with relative or absolute mismatch volumes (p = 0.458 and p = 0.921). Higher collateralization gradings were associated with small absolute mismatch volumes (p = 0.004 and p < 0.001). Internal carotid artery (ICA) occlusions were associated with large absolute mismatch volumes (p = 0.004). Multivariate analysis confirmed that ICA occlusion was associated with large absolute mismatch volumes (p = 0.005), and high collateral grade was associated with small absolute mismatch volumes (p = 0.017).

Conclusions

There is no significant correlation between initial CTP mismatch and time after symptom onset. Predictors of mismatch size include the extent of the collaterals and a proximal location of the occlusion.

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    Authors and Affiliations

    1. Department of Neurology, University of Munich Hospitals, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany

      Louisa von Baumgarten & Andreas Straube

    2. Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany

      Kolja M. Thierfelder, Sebastian E. Beyer, Alena B. Baumann, Christine Bollwein, Maximilian F. Reiser & Wieland H. Sommer

    3. Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany

      Hendrik Janssen

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    1. Louisa von Baumgarten
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    Correspondence to Louisa von Baumgarten.

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    We declare that all human and animal studies have been approved by the institutional Ethics Committee of the Medical Faculty of the Ludwigs-Maximilians University Munich and have therefore been performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments. We declare that the Ethics Committee waived informed patient consent.

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    LvB and KMT contributed equally to this work.

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    von Baumgarten, L., Thierfelder, K.M., Beyer, S.E. et al. Early CT perfusion mismatch in acute stroke is not time-dependent but relies on collateralization grade. Neuroradiology 58, 357–365 (2016). https://doi.org/10.1007/s00234-016-1643-8

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