Validation and iteration of CT perfusion defined malignant profile thresholds for acute ischemic stroke. International journal of stroke : official journal of the International Stroke Society Keenan, K. J., Christensen, S., Inoue, M., Mlynash, M., Albers, G. W., Smith, W. S. 2019: 1747493019832987


BACKGROUND: Malignant profile computed tomography perfusion (CTP) lesions are associated with poor outcomes after administration of intravenous tissue-plasminogen activator (IV-tPA) for ischemic stroke.AIMS: To determine whether published CTP-based lesion thresholds predictive of poor outcomes in a predominantly 8cm of CTP anatomic coverage cohort would predict poor outcomes in an independent 4cm of CTP anatomic coverage cohort and to generate optimized 4cm CTP thresholds.METHODS: Ischemic stroke patients with baseline CTP imaging with 4cm of anatomic coverage before receiving IV-tPA at a single institution were retrospectively studied. Perfusion lesion time to maximum of tissue residue function (Tmax) and cerebral blood flow (CBF) volumes were determined using RAPID automated software. Fisher's exact tests assessed associations between lesion thresholds and outcomes. Receiver operating characteristic (ROC) curves generated optimized thresholds for 4cm of CTP coverage.RESULTS: Sixty-three patients were included. Poor outcomes were associated with published thresholds of Tmax >6s>103mL, Tmax>8s>86mL, and Tmax>10s>78mL but not CBF core >53mL. Thresholds optimized for 4cm of CTP coverage and associated with poor outcomes were Tmax>6s>100mL, Tmax>8s>65mL, Tmax>10s>46mL, and CBF core >39mL.CONCLUSIONS: We validated the ability of published CTP Tmax lesion volume thresholds to predict poor outcomes despite IV-tPA in an independent cohort using only 4cm of CTP anatomical coverage. A CBF>39mL threshold, rather than the predominantly 8cm CTP coverage derived CBF threshold of >53mL, was associated with poor outcomes in this 4cm CTP coverage cohort.

View details for DOI 10.1177/1747493019832987

View details for PubMedID 30794104