title: CT perfusion cerebral blood volume does not always predict infarct core in acute ischemic stroke.
abstract: We investigated the practical clinical utility of the CT perfusion (CTP) cerebral blood volume (CBV) parameter for differentiating salvageable from non-salvageable tissue in acute ischemic stroke (AIS). Fifty-five patients with AIS were imaged within 6 h from onset using CTP. Admission CBV defect (CBVD) volume was outlined using previously established gray and white matter CBV thresholds for infarct core. Admission cerebral blood flow (CBF) hypoperfusion and CBF/CBV mismatch were visually evaluated. Truncation of the ischemic time-density curve (ITDC) and hypervolemia status at admission, recanalization at 24-h CT angiography, hemorrhagic transformation (HT) at 24 h and/or 7-day non-contrast CT (NCCT), final infarct volume as indicated by 3-month NCCT defect (NCCTD) and 3-month modified Rankin Score were determined. Patients with recanalization and no truncation had the highest correlation (R = 0.81) and regression slope (0.80) between CBVD and NCCTD. Regression slopes were close to zero for patients with admission hypervolemia with/without recanalization. Hypervolemia underestimated (p = 0.02), while recanalization and ITDC truncation overestimated (p = 0.03) the NCCTD. Among patients with confirmed recanalization at 24 h, 38 % patients had an admission CBF/CBV mismatch within normal appearing areas on respective NCCT. 83 % of these patients developed infarction in admission hypervolemic CBF/CBV mismatch tissue. A reduction in CBV is a valuable predictor of infarct core when the acquisition of ITDC data is complete and hypervolemia is absent within the tissue destined to infarct. Raised or normal CBV is not always indicative of salvageable tissue, contrary to the current definition of penumbra.
authors.affiliation: Calgary Stroke Program, University of Calgary, Calgary, AB, Canada.|Imaging Program, Lawson Health Research Institute, London, ON, Canada.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: d'Esterre
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Roversi
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Padroni
authors.affiliation: Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernardoni
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tamborino
authors.affiliation: Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Vito
authors.affiliation: Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Azzini
authors.affiliation: Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Marcello
authors.affiliation: Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saletti
authors.affiliation: Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ceruti
authors.affiliation: Calgary Stroke Program, University of Calgary, Calgary, AB, Canada.|Imaging Program, Lawson Health Research Institute, London, ON, Canada.|Imaging Research Lab, Robarts Research Institute, London, ON, Canada.
authors.forename: Ting Yim
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy. henryfai@tin.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fainardi
mesh_terms: D000368:Aged; D001810:Blood Volume / Q000502:physiology*; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: CT perfusion; Cerebral blood volume; Hypervolemia; Infarct core; Penumbra