Implementation of automated quantified CTP in patients with NIHSS ≥6: a single center experience

Mustafa Abdulridha Zaboon Almajidi, Mohammed Mahmood Omairi, Bashar Nasri Wadeea Ajamaya, Ivana Jevtic, Ronald Antulov*


Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review


Introduction: Advanced stroke imaging with CT in
patients with suspected acute ischemic stroke (AIS) can
include CT perfusion (CTP). Several studies showed that
selecting patients for reperfusion treatment (RT) in the
late time window, >4.5 hours for intravenous thrombolysis
and >6 hours mechanical thrombectomy, based on
automated CTP software for quantifying ischemic core
volume (ICV) and perfusion lesion volume (PLV) resulted
in better functional outcome following RT. Nevertheless,
routine CTP application for identifying RT candidates in
the early time window, <4.5 for intravenous thrombolysis
and <6 hours for mechanical thrombectomy, is not
recommended, except for diagnosing stroke mimics. The
National Institutes of Health Stroke Scale (NIHSS) is a
useful tool for large vessel occlusion (LVO) prediction,
where NIHSS ≥6 shows high sensitivity for LVO. We
investigated the impact of automated quantified CTP in
a cohort of consecutive patients with suspected AIS and
Methods: We performed a single center retrospective
analysis of quantified CTP results of patients with suspected
AIS that were evaluated at our emergency department
during 6 months, with a NIHSS ≥6, regardless of
time of symptom onset. Patients underwent the hospital
imaging protocol for suspected AIS consisting of a noncontrast
head CT (NCCT), CT angiography (CTA) of
the head and neck and CTP. Quantified CTP results were
estimated by RAPID (iSchemaView). Bleeding or a space
occupying lesion on the NCCT were exclusion criteria.
Presence of any intracranial vessel occlusion was assessed
on the CTA. Control NCCT or brain MRI done after the
initial suspected AIS imaging were used to confirm AIS
or a stroke mimic.
Results: Of the 48 patients with NIHSS ≥6, 8 (16%) had
a bleeding. The included 40 patients had NIHSS between
6 and 22 (median 10) of which 23 (57%) patients had a
NIHSS between 6 and 10. Twelve patients with NIHSS
between 6 and 10 showed ICV and PLV equal to 0 ml,
where on the control examination a lacunar infarct or
stroke mimic was found in 5 patients. In the group of
patients with NIHSS between 11 and 22, just two patients
(1 with NIHSS 13 and 1 with NIHSS 15) were negative
for an intracranial vessel occlusion.
Discussion & Conclusion: Applying quantified CTP in
the group of patients with NIHSS between 6 and 10 results
in a substantial number of negative quantified CTP findings,
therefore using MRI for AIS detection and exclusion
of stroke mimics would be optimal.
Udgave nummerSuppl. 1
Sider (fra-til)598-599
Antal sider1
StatusUdgivet - sep. 2023
BegivenhedEuropean Society of Neuroradiology : Diagnostic and Interventional - 46th annual meeting - Vienna, Østrig
Varighed: 20. sep. 202324. sep. 2023


KonferenceEuropean Society of Neuroradiology


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