Optimal Cerebral Blood Flow Thresholds for Ischemic Core Estimation Using Computed Tomography Perfusion and Diffusion-Weighted Imaging

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-12-26 DOI:10.1002/ana.27169

Nakhoon Kim MD, MS, Wi-Sun Ryu MD, PhD, Sue Young Ha MD, MS, Jun Yup Kim MD, MS, Jihoon Kang MD, PhD, Sung Hyun Baik MD, MS, Cheolkyu Jung MD, PhD, Moon-Ku Han MD, PhD, Hee-Joon Bae MD, PhD, Longting Lin MD, PhD, Mark Parsons MD, PhD, Beom Joon Kim MD, PhD

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Abstract

Objective

Computed tomography perfusion (CTP) imaging is crucial in quantifying cerebral blood flow (CBF) and thereby making an endovascular treatment (EVT) after large vessel occlusion. However, CTP is prone to overestimating the ischemic core. We sought to delineate the optimal regional CBF (rCBF) thresholds of pre-EVT CTP.

Methods

We collected acute ischemic stroke patients due to large vessel occlusion who achieved successful recanalization with baseline CTP, immediate post-EVT diffusion-weighted image (DWI) within 3 hours, and delayed post-EVT DWI between 24 and 196 hours. Core volumes estimated by CTP at various rCBF thresholds were validated against immediate and delayed DWI lesion volumes.

Results

A total of 175 acute large vessel occlusion patients were included. Baseline CTP was taken in a median of 24 minutes (interquartile range [IQR] 21–31 minutes) after arrival; after the CTP, groin puncture in a median of 37 minutes (IQR 28–52 minutes), immediate post-EVT DWI scans in a median of 1.6 hours (IQR 0.8–2.1 hours), and delayed DWI scans in a median of 89 hours (IQR 69–106 hours). The correlations between the rCBF thresholds were the best at rCBF <22% for immediate DWI (0.64; 95% CI 0.55–0.73) and at rCBF <30% for delayed DWI (0.69; 95% CI 0.61–0.76). The interval between CTP and recanalization was inversely correlated with the overestimation of ischemic core volume compared with the subsequent DWI.

Interpretation

Optimal rCBF thresholds for estimating ischemic core using CTP depend significantly on the timing of DWI post-EVT and CTP to recanalization delay. The optimal rCBF thresholds for ischemic core estimation may vary depending on the clinical setting. ANN NEUROL 2025;97:919–929

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计算机断层扫描灌注和弥散加权成像用于缺血性核心估计的最佳脑血流阈值。

目的：ct灌注成像（CTP）是大血管闭塞后定量脑血流量（CBF）并进行血管内治疗（EVT）的重要手段。然而，CTP容易高估缺血核心。我们试图描述evt前CTP的最佳区域CBF （rCBF）阈值。方法：我们收集了因大血管闭塞导致的急性缺血性脑卒中患者，他们在基线CTP、evt后立即DWI（3小时内）和evt后延迟DWI（24 - 196小时）完成了成功的再通。CTP在不同rCBF阈值下估计的核心体积与即时和延迟DWI病变体积进行了验证。结果：共纳入175例急性大血管闭塞患者。基线CTP在患者到达后24分钟（四分位间距[IQR] 21-31分钟）内进行；CTP后，腹股沟穿刺平均37分钟（IQR 28-52分钟），evt后立即DWI扫描平均1.6小时（IQR 0.8-2.1小时），延迟DWI扫描平均89小时（IQR 69-106小时）。rCBF阈值之间的相关性在rCBF解释中是最好的：使用CTP估计缺血核心的最佳rCBF阈值在很大程度上取决于evt后DWI和CTP再通延迟的时间。估计缺血性核心的最佳rCBF阈值可能因临床情况而异。Ann neurol 2024。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.