Background

Malignant profile computed tomography perfusion (CTP) lesions are associated with poor outcomes after administration of intravenous tissue-plasminogen activator (IV-tPA) for ischemic stroke.

Aims

To determine whether published CTP-based lesion thresholds predictive of poor outcomes in a predominantly 8 cm of CTP anatomic coverage cohort would predict poor outcomes in an independent 4 cm of CTP anatomic coverage cohort and to generate optimized 4 cm CTP thresholds.

Methods

Ischemic stroke patients with baseline CTP imaging with 4 cm of anatomic coverage before receiving IV-tPA at a single institution were retrospectively studied. Perfusion lesion time to maximum of tissue residue function (Tmax) and cerebral blood flow (CBF) volumes were determined using RAPID automated software. Fisher's exact tests assessed associations between lesion thresholds and outcomes. Receiver operating characteristic (ROC) curves generated optimized thresholds for 4 cm of CTP coverage.

Results

Sixty-three patients were included. Poor outcomes were associated with published thresholds of Tmax >6 s > 103 mL, Tmax > 8 s > 86 mL, and Tmax > 10 s > 78 mL but not CBF core >53 mL. Thresholds optimized for 4 cm of CTP coverage and associated with poor outcomes were Tmax > 6 s > 100 mL, Tmax > 8 s > 65 mL, Tmax >10 s > 46 mL, and CBF core >39 mL.

Conclusions

We validated the ability of published CTP Tmax lesion volume thresholds to predict poor outcomes despite IV-tPA in an independent cohort using only 4 cm of CTP anatomical coverage. A CBF > 39 mL threshold, rather than the predominantly 8 cm CTP coverage derived CBF threshold of >53 mL, was associated with poor outcomes in this 4 cm CTP coverage cohort.

中文翻译：

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急性缺血性卒中的CT灌注定义的恶性谱阈值的验证和迭代

背景

给予缺血性中风的静脉内组织纤溶酶原激活剂（IV-tPA）后，恶性轮廓计算机断层扫描灌注（CTP）病变与不良预后相关。

目的

若要确定已发布的基于CTP的病变阈值是否可预测主要在8 cm CTP解剖覆盖队列中的不良结局，是否可以预测独立的4 cm CTP解剖覆盖队列中的不良结局并生成优化的4 cm CTP阈值。

方法

回顾性研究在单个机构接受IV-tPA之前具有4 cm解剖覆盖的基线CTP成像的缺血性卒中患者。使用RAPID自动化软件确定达到最大组织残留功能（Tmax）和脑血流量（CBF）量的灌注损伤时间。Fisher的精确测试评估了病变阈值与结局之间的关联。接收器工作特性（ROC）曲线为4 cm CTP覆盖范围生成了优化阈值。

结果

包括六十三名患者。不良的预后与已公布的阈值Tmax> 6 s> 103 mL，Tmax> 8 s> 86 mL，Tmax> 10 s> 78 mL，但CBF核心> 53 mL无关。为4 cm CTP覆盖而优化并与不良结果相关的阈值是Tmax> 6 s> 100 mL，Tmax> 8 s> 65 mL，Tmax> 10 s> 46 mL，以及CBF核心> 39 mL。

结论

我们在仅使用4 cm CTP解剖覆盖范围的独立队列中，验证了已发表的CTP Tmax病变体积阈值预测IV-tPA不良结局的能力。在这4 cm CTP覆盖人群中，CBF> 39 mL阈值，而不是主要由8 cm CTP覆盖率得出的CBF阈值> 53 mL，与不良结果相关。