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Accuracy of 'At Risk' Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions
- Source :
- Journal of Neuroimaging, 29(3), 371-375. Wiley-Blackwell, Journal of neuroimaging, 29(3), 371-375. Wiley-Blackwell
- Publication Year :
- 2019
-
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.
- Subjects :
- Male
medicine.medical_specialty
Infarction
Large vessel
Perfusion scanning
Logistic regression
Brain Ischemia
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Internal medicine
Linear regression
Occlusion
medicine
Humans
Radiology, Nuclear Medicine and imaging
In patient
Stroke
Aged
Cerebral Revascularization
business.industry
Brain
Middle Aged
medicine.disease
Treatment Outcome
Cardiology
Female
Neurology (clinical)
Tomography, X-Ray Computed
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 10512284
- Volume :
- 29
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of neuroimaging
- Accession number :
- edsair.doi.dedup.....305664a0707439131a25afb2f2ae4650