title: Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME.
abstract: OBJECTIVE
  Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile.
  
  
  METHODS
  Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI).
  
  
  RESULTS
  A total of 151 patients with baseline imaging with CT perfusion (79%) or multimodal MRI (21%) were included. The median baseline ischemic core volume was 6 ml (interquartile range= 0-16). Ischemic core volumes correlated with 27-hour infarct volumes in patients who achieved reperfusion (r = 0.58, p < 0.0001). In patients who did not reperfuse (<10% reperfusion), baseline Tmax > 6-second lesion volumes correlated with 27-hour infarct volume (r = 0.78, p = 0.005). In target mismatch patients, the union of baseline core and early follow-up Tmax > 6-second volume (ie, predicted infarct volume) correlated with the 27-hour infarct volume (r = 0.73, p < 0.0001); the median absolute difference between the observed and predicted volume was 13 ml.
  
  
  CONCLUSIONS
  Ischemic core and hypoperfusion volumes, obtained primarily from CT perfusion scans, predict 27-hour infarct volume in acute stroke patients who were treated with reperfusion therapies.
authors.affiliation: Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafe
authors.affiliation: Department of Neurology, Duisburg-Essen University Hospital, Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vitor M
authors.initials: VM
authors.lastname: Pereira
authors.affiliation: Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.affiliation: Department of Radiology and Neuroradiology, Christian Albrechts University of Kiel, Kiel, Germany.
authors.forename: Olav
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.affiliation: Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Department of Neurosurgery, Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.affiliation: Department of Radiology, Erlanger Hospital at University of Tennessee, Chattanooga, TN.
authors.forename: Blaise W
authors.initials: BW
authors.lastname: Baxter
authors.affiliation: Division of Neurology, Erlanger Hospital at University of Tennessee, Chattanooga, TN.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Devlin
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
authors.affiliation: Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Reddy
authors.affiliation: Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany.
authors.forename: Richard du Mesnil
authors.initials: Rdu M
authors.lastname: de Rochemont
authors.affiliation: Department of Neurology, Goethe University Hospital, Frankfurt, Germany.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.affiliation: Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA.
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.affiliation: Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003287:Contrast Media; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator