Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept
Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept
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DOI：
10.1136/neurintsurg-2016-012494
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发表时间：
2017-01-01
影响因子：
4.8
通讯作者：
Ribo, Marc
中科院分区：
文献类型：
--
作者：
Boned, Sandra;Padroni, Marina;Ribo, Marc
在入院时识别梗死核心对于确定可挽救组织的数量和指示再灌注治疗是至关重要的。CT灌注（CTP）将梗死核心确定为严重低灌注区，但低灌注和梗死核心之间的相关性可能是时间依赖性的，因为它不是组织损伤的直接指标。本研究的目的是描述那些在CTP上的入院核心病变在随访imaging.Methods上没有反映梗死的病例，我们研究了在入院时接受CTP但根据非造影CT阿尔伯塔卒中计划早期CT评分（ASPECTS）>6接受血管内血栓切除术的脑大血管闭塞患者。在初始脑血容量（CBV）CTP上测量入院梗死核心，并在随访CT上测量最终梗死。我们定义幽灵梗死核心（GIC）为初始核心减去最终梗死>10 mL。中位美国国立卫生研究院卒中量表（NIHSS）评分为17（11-20），从症状到CTP的中位时间为215（87-327）min，再通率（TICI 2b-3）为77%。30例患者（38%）GIC >10 mL。GIC >10 mL与再通率（TICI 2b-3：90%vs68%，p=0.026）、住院时间（10 mL：66.6%vs39%，p=0.017）相关。基于CTP不匹配概念选择患者进行再灌注治疗可能会拒绝对可能仍然受益于再灌注的患者进行治疗。
Background Identifying infarct core on admission is essential to establish the amount of salvageable tissue and indicate reperfusion therapies. Infarct core is established on CT perfusion (CTP) as the severely hypoperfused area, however the correlation between hypoperfusion and infarct core may be time-dependent as it is not a direct indicator of tissue damage. This study aims to characterize those cases in which the admission core lesion on CTP does not reflect an infarct on follow-up imaging.Methods We studied patients with cerebral large vessel occlusion who underwent CTP on admission but received endovascular thrombectomy based on a non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS) >6. Admission infarct core was measured on initial cerebral blood volume (CBV) CTP and final infarct on follow-up CT. We defined ghost infarct core (GIC) as initial core minus final infarct >10 mL.Results 79 patients were studied. Median National Institutes of Health Stroke Scale (NIHSS) score was 17 (11-20), median time from symptoms to CTP was 215 (87-327) min, and recanalization rate (TICI 2b-3) was 77%. Thirty patients (38%) presented with a GIC >10 mL. GIC >10 mL was associated with recanalization (TICI 2b-3: 90% vs 68%; p=0.026), admission glycemia (10 mL (66.6% vs 39%; p=0.017).Conclusions CT perfusion may overestimate final infarct core, especially in the early time window. Selecting patients for reperfusion therapies based on the CTP mismatch concept may deny treatment to patients who might still benefit from reperfusion.