title: Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion.
abstract: Whole brain computed tomography perfusion (CTP) has the potential to select eligible patients for reperfusion therapy. We aimed to find the optimal thresholds on baseline CTP for ischemic core and penumbra in acute ischemic stroke. We reviewed patients with acute ischemic stroke in the anterior circulation, who underwent baseline whole brain CTP, followed by intravenous thrombolysis and perfusion imaging at 24 hours. Patients were divided into those with major reperfusion (to define the ischemic core) and minimal reperfusion (to define the extent of penumbra). Receiver operating characteristic (ROC) analysis and volumetric consistency analysis were performed separately to determine the optimal threshold by Youden's Index and mean magnitude of volume difference, respectively. From a series of 103 patients, 22 patients with minimal-reperfusion and 47 with major reperfusion were included. Analysis revealed delay time ≥ 3 s most accurately defined penumbra (AUC = 0.813; 95% CI, 0.812-0.814, mean magnitude of volume difference = 29.1 ml). The optimal threshold for ischemic core was rCBF ≤ 30% within delay time ≥ 3 s (AUC = 0.758; 95% CI, 0.757-0.760, mean magnitude of volume difference = 10.8 ml). In conclusion, delay time ≥ 3 s and rCBF ≤ 30% within delay time ≥ 3 s are the optimal thresholds for penumbra and core, respectively. These results may allow the application of the mismatch on CTP to reperfusion therapy.
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Yannan
authors: Y
authors: Yu
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Quan
authors: Q
authors: Han
authors: Department of Radiology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Xinfa
authors: X
authors: Ding
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Qingmeng
authors: Q
authors: Chen
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Keqi
authors: K
authors: Ye
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Sheng
authors: S
authors: Zhang
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Shenqiang
authors: S
authors: Yan
authors: Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
authors: Bruce C V
authors: BC
authors: Campbell
authors: Department of Neurology, John Hunter Hospital, and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
authors: Mark W
authors: MW
authors: Parsons
authors: Department of Neurology, Shanghai Jiaotong University Affiliated Branch of People's No. 1 Hospital, Shanghai, China.
authors: Shaoshi
authors: S
authors: Wang
authors: Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
authors: Min
authors: M
authors: Lou
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult