BACKGROUND Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area. PURPOSE Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow (CBF) as the reference parameter to determine infarct core. METHODS We performed a retrospective, single-center analysis of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions considering noncontrast CT Alberta Stroke Program Early CT Score ≥6 in patients with pretreatment CTP. We used the RAPID® software to measure admission infarct core based on initial CBF. The final infarct was extracted from follow-up CT. GIC was defined as initial core minus final infarct > 10 mL. RESULTS A total of 123 patients were included. The median National Institutes of Health Stroke Scale score was 18 (13-20), the median time from symptoms to CTP was 188 (67-288) min, and the recanalization rate (Thrombolysis in Cerebral Infarction score 2b, 2c, or 3) was 83%. Twenty patients (16%) presented with GIC. GIC was associated with shorter time to recanalization (150 [105-291] vs. 255 [163-367] min, p = 0.05) and larger initial CBF core volume (38 [26-59] vs. 6 [0-27] mL, p < 0.001). An adjusted logistic regression model identified time to recanalization < 302 min (OR 4.598, 95% CI 1.143-18.495, p = 0.032) and initial infarct volume (OR 1.01, 95% CI 1.001-1.019, p = 0.032) as independent predictors of GIC. At 24 h, clinical improvement was more frequent in patients with GIC (80 vs. 49%, p = 0.01). CONCLUSIONS CTP CBF < 30% may overestimate infarct core volume, especially in patients imaged in the very early time window and with fast complete reperfusion. Therefore, the CTP CBF technique may exclude patients who would benefit from endovascular treatment.

中文翻译：

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幽灵梗塞核心和入院计算机断层扫描灌注：重新定义神经影像学在急性缺血性中风中的作用。

背景技术确定梗死范围的大小对于选择患者进行再灌注治疗至关重要。基于脑血容量的计算机断层扫描灌注 (CTP) 可能会高估入院时的梗死核心，因此在确定的病变区域中包括幽灵梗死核心 (GIC)。目的 我们的目标是使用 CTP 脑血流 (CBF) 作为确定梗死核心的参考参数来确认和更好地表征 GIC 现象。方法 我们对大脑中部或颅内颈内动脉闭塞的连续血栓切除术进行了回顾性、单中心分析，考虑到治疗前 CTP 患者的非增强 CT 艾伯塔中风计划早期 CT 评分≥6。我们使用 RAPID® 软件根据初始 CBF 测量入院梗死核心。最后的梗塞是从随访 CT 中提取的。GIC 定义为初始核心减去最终梗死 > 10 mL。结果共纳入123例患者。美国国立卫生研究院卒中量表评分中位数为 18 (13-20)，从出现症状到 CTP 的中位时间为 188 (67-288) 分钟，再通率（脑梗死溶栓评分 2b、2c 或 3）为 83%。20 名患者 (16%) 出现 GIC。GIC 与更短的再通时间相关（150 [105-291] vs. 255 [163-367] min，p = 0.05）和更大的初始 CBF 核心体积（38 [26-59] vs. 6 [0-27]毫升，p < 0.001）。调整后的逻辑回归模型确定再通时间 < 302 分钟 (OR 4.598, 95% CI 1.143-18.495, p = 0.032) 和初始梗死体积 (OR 1.01, 95% CI 1.001-1.019, p = 0.032) 作为独立预测因子投资证。在 24 小时，GIC 患者的临床改善更为频繁（80% 对 49%，p = 0.01）。结论 CTP CBF < 30% 可能会高估梗死核心体积，尤其是在非常早的时间窗口成像和快速完全再灌注的患者中。因此，CTP CBF 技术可能会排除将从血管内治疗中受益的患者。