title: Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy.
abstract: OBJECTIVE
  CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy.
  
  
  METHODS
  Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score.
  
  
  RESULTS
  Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively.
  
  
  CONCLUSIONS
  CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy.
  
  
  CONCLUSIONS
  • CBV-ASPECTS is a significant predictor of clinical outcome. • Single phase CTA-ASPECTS has low predictive value. • Using CBV-ASPECTS, raters identified futile reperfusions in 96 % of the cases.
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsogkas
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schregel
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Behme
authors.affiliation: Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Wasser
authors.affiliation: Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Ilko
authors.initials: I
authors.lastname: Maier
authors.affiliation: Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Liman
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Robert Koch 40, 37075, Goettingen, Germany. m.psychogios@med.uni-goettingen.de.
authors.forename: Marios Nikos
authors.initials: MN
authors.lastname: Psychogios
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001810:Blood Volume / Q000502:physiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D015588:Observer Variation; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator
keywords: Neuroimaging; Patient selection; Stroke; Thrombectomy; X-ray computed