Value of Pre-intervention CT Perfusion Imaging in Acute Ischemic Stroke Prognosis

Overview

Journal Diagn Interv Radiol

Publisher Galenos Publishing House

Date 2021 Nov 18

PMID 34792033

Citations 2

Authors

Anubhav Katyal

Sonu Menachem Maimonides Bhaskar

Affiliations

Soon will be listed here.

Abstract

Noninvasive imaging plays an important role in acute stroke towards diagnosis and ongoing management of patients. Systemic thrombolysis and endovascular thrombectomy (EVT) are proven treatments currently used in standards of care in acute stroke settings. The role of computed tomography angiography (CTA) in selecting patients with large vessel occlusion for EVT is well established. However, the value of CT perfusion (CTP) imaging in predicting outcomes after stroke remains ambiguous. This article critically evaluates the value of multimodal CT imaging in early diagnosis and prognosis of acute ischemic stroke with a focus on the role of CTP in delineating tissue characteristics, patient selection, and outcomes after reperfusion therapy. Insights on various technical and clinical considerations relevant to CTP applications in acute ischemic stroke, recommendations for existing workflow, and future areas of research are discussed.

Citing Articles

Neuroimaging-Based Responses to Blood Pressure Augmentation in Acute Ischaemic Stroke: A Systematic Review.

Goh R, El-Masri S, Zweck D, Spicer D, Ng F, Bacchi S Biomed Hub. 2025; 10(1):50-56.

PMID: 40041759 PMC: 11879148. DOI: 10.1159/000543341.

Seizures Following Carotid Endarterectomy: A Comprehensive Meta-Analysis of 69,479 Patients and Evidence-Based Recommendations for Perioperative Care.

Rajesh K, Shen H, Bhaskar S Diagnostics (Basel). 2025; 15(1).

PMID: 39795534 PMC: 11840276. DOI: 10.3390/diagnostics15010006.

Laser speckle contrast imaging for blood flow monitoring in predicting outcomes after cerebral ischemia-reperfusion injury in mice.

Yin L, Yu T, Cheng L, Liu X, Zhang W, Zhang H BMC Neurosci. 2022; 23(1):80.

PMID: 36575381 PMC: 9795726. DOI: 10.1186/s12868-022-00769-x.

Neurological deterioration and computed tomography perfusion changes with increased time to peak in lacunar stroke.

Farooqui A, Albayram M, Ballur Narayana Reddy V, Nagaraja N Brain Circ. 2022; 8(1):17-23.

PMID: 35372724 PMC: 8973445. DOI: 10.4103/bc.bc_68_21.

References

Toni D, Fiorelli M, Zanette E, Sacchetti M, Salerno A, Argentino C . Early spontaneous improvement and deterioration of ischemic stroke patients. A serial study with transcranial Doppler ultrasonography. Stroke. 1998; 29(6):1144-8. DOI: 10.1161/01.str.29.6.1144. View

Puetz V, Dzialowski I, Hill M, Subramaniam S, Sylaja P, Krol A . Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Int J Stroke. 2008; 3(4):230-6. DOI: 10.1111/j.1747-4949.2008.00221.x. View

Rebello L, Bouslama M, Haussen D, Dehkharghani S, Grossberg J, Belagaje S . Endovascular Treatment for Patients With Acute Stroke Who Have a Large Ischemic Core and Large Mismatch Imaging Profile. JAMA Neurol. 2016; 74(1):34-40. DOI: 10.1001/jamaneurol.2016.3954. View

Parsons M, Pepper E, Chan V, Siddique S, Rajaratnam S, Bateman G . Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol. 2005; 58(5):672-9. DOI: 10.1002/ana.20638. View

Borst J, Berkhemer O, Roos Y, van Bavel E, van Zwam W, van Oostenbrugge R . Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment. Stroke. 2015; 46(12):3375-82. DOI: 10.1161/STROKEAHA.115.010564. View

Menon B, dEsterre C, Qazi E, Almekhlafi M, Hahn L, Demchuk A . Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology. 2015; 275(2):510-20. DOI: 10.1148/radiol.15142256. View

Saver J, Goyal M, Bonafe A, Diener H, Levy E, Pereira V . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372(24):2285-95. DOI: 10.1056/NEJMoa1415061. View

Mishra N, Albers G, Davis S, Donnan G, Furlan A, Hacke W . Mismatch-based delayed thrombolysis: a meta-analysis. Stroke. 2009; 41(1):e25-33. DOI: 10.1161/STROKEAHA.109.566869. View

Albers G, Marks M, Kemp S, Christensen S, Tsai J, Ortega-Gutierrez S . Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018; 378(8):708-718. PMC: 6590673. DOI: 10.1056/NEJMoa1713973. View

10.

Broocks G, Hanning U, Flottmann F, Schonfeld M, Faizy T, Sporns P . Clinical benefit of thrombectomy in stroke patients with low ASPECTS is mediated by oedema reduction. Brain. 2019; 142(5):1399-1407. DOI: 10.1093/brain/awz057. View

11.

Campbell B, Majoie C, Albers G, Menon B, Yassi N, Sharma G . Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2018; 18(1):46-55. DOI: 10.1016/S1474-4422(18)30314-4. View

12.

Hom J, Dankbaar J, Soares B, Schneider T, Cheng S, Bredno J . Blood-brain barrier permeability assessed by perfusion CT predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. AJNR Am J Neuroradiol. 2010; 32(1):41-8. PMC: 7964964. DOI: 10.3174/ajnr.A2244. View

13.

Kucinski T, Koch C, Eckert B, Becker V, KROMER H, Heesen C . Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke. Neuroradiology. 2003; 45(1):11-8. DOI: 10.1007/s00234-002-0881-0. View

14.

Hirano T, Yonehara T, Inatomi Y, Hashimoto Y, Uchino M . Presence of early ischemic changes on computed tomography depends on severity and the duration of hypoperfusion: a single photon emission-computed tomographic study. Stroke. 2005; 36(12):2601-8. DOI: 10.1161/01.STR.0000189990.31225.82. View

15.

Chen C, Parsons M, Clapham M, Oldmeadow C, Levi C, Lin L . Influence of Penumbral Reperfusion on Clinical Outcome Depends on Baseline Ischemic Core Volume. Stroke. 2017; 48(10):2739-2745. DOI: 10.1161/STROKEAHA.117.018587. View

16.

Fanou E, Knight J, Aviv R, Hojjat S, Symons S, Zhang L . Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke. AJNR Am J Neuroradiol. 2015; 36(12):2285-91. PMC: 7964273. DOI: 10.3174/ajnr.A4453. View

17.

Puig J, Blasco G, Daunis-I-Estadella P, van Eendendburg C, Carrillo-Garcia M, Aboud C . High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke. PLoS One. 2017; 12(11):e0188238. PMC: 5705117. DOI: 10.1371/journal.pone.0188238. View

18.

Horsch A, Bennink E, van Seeters T, Kappelle L, van der Graaf Y, Mali W . Computed Tomography Perfusion Derived Blood-Brain Barrier Permeability Does Not Yet Improve Prediction of Hemorrhagic Transformation. Cerebrovasc Dis. 2018; 45(1-2):26-32. PMC: 5972514. DOI: 10.1159/000485043. View

19.

Heit J, Wintermark M . Perfusion Computed Tomography for the Evaluation of Acute Ischemic Stroke: Strengths and Pitfalls. Stroke. 2016; 47(4):1153-8. DOI: 10.1161/STROKEAHA.116.011873. View

20.

Rao V, Christensen S, Yennu A, Mlynash M, Zaharchuk G, Heit J . Ischemic Core and Hypoperfusion Volumes Correlate With Infarct Size 24 Hours After Randomization in DEFUSE 3. Stroke. 2019; 50(3):626-631. DOI: 10.1161/STROKEAHA.118.023177. View