CT Perfusion Derived rCBV < 42% Lesion Volume Is Independently Associated with Followup FLAIR Infarct Volume in Anterior Circulation Large Vessel Occlusion

Dhairya A Lakhani; Aneri B Balar; Hamza Salim; Manisha Koneru; Sijin Wen; Burak Ozkara; Hanzhang Lu; Richard Wang; Meisam Hoseinyazdi; Risheng Xu; Mehreen Nabi; Ishan Mazumdar; Andrew Cho; Kevin Chen; Sadra Sepehri; Nathan Hyson; Victor Urrutia; Licia Luna; Argye E Hillis; Jeremy J Heit; Greg W Albers; Ansaar T Rai; Adam A Dmytriw; Tobias D Faizy; Max Wintermark; Kambiz Nael; Vivek S Yedavalli

doi:10.3390/diagnostics14080845

CT Perfusion Derived rCBV < 42% Lesion Volume Is Independently Associated with Followup FLAIR Infarct Volume in Anterior Circulation Large Vessel Occlusion

Diagnostics (Basel). 2024 Apr 19;14(8):845. doi: 10.3390/diagnostics14080845.

Authors

Dhairya A Lakhani¹, Aneri B Balar¹, Hamza Salim¹, Manisha Koneru², Sijin Wen³, Burak Ozkara⁴, Hanzhang Lu¹, Richard Wang¹, Meisam Hoseinyazdi¹, Risheng Xu¹, Mehreen Nabi¹, Ishan Mazumdar¹, Andrew Cho¹, Kevin Chen¹, Sadra Sepehri¹, Nathan Hyson¹, Victor Urrutia¹, Licia Luna¹, Argye E Hillis⁴, Jeremy J Heit⁵, Greg W Albers⁵, Ansaar T Rai⁶, Adam A Dmytriw⁷, Tobias D Faizy⁸, Max Wintermark⁹, Kambiz Nael¹⁰, Vivek S Yedavalli¹

Affiliations

¹ Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA.
² Cooper Medical School, Rowan University, Camden, NJ 08103, USA.
³ Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA.
⁴ Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA.
⁵ Department of Neurology, Stanford University, Stanford, CA 94305, USA.
⁶ Department of Neuroradiology, West Virginia University, Morgantown, WV 26506, USA.
⁷ Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
⁸ Department of Radiology, Neuroendovascular Division, University Medical Center Münster, 48149 Münster, Germany.
⁹ Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA.
¹⁰ Division of Neuroradiology, Department of Radiology, University of California San Francisco (UCSF), San Francisco, CA 94143, USA.

Abstract

Pretreatment CT Perfusion (CTP) parameter rCBV < 42% lesion volume has recently been shown to predict 90-day mRS. In this study, we aim to assess the relationship between rCBV < 42% and a radiographic follow-up infarct volume delineated on FLAIR images. In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 9 January 2017 and 10 January 2023. Follow-up FLAIR imaging was used to determine the final infarct volume. Student t, Mann-Whitney-U, and Chi-Square tests were used to assess differences. Spearman's rank correlation and linear regression analysis were used to assess associations between rCBV < 42% and follow-up infarct volume on FLAIR. In total, 158 patients (median age: 68 years, 52.5% female) met our inclusion criteria. rCBV < 42% (ρ = 0.56, p < 0.001) significantly correlated with follow-up-FLAIR infarct volume. On multivariable linear regression analysis, rCBV < 42% lesion volume (beta = 0.60, p < 0.001), ASPECTS (beta = -0.214, p < 0.01), mTICI (beta = -0.277, p < 0.001), and diabetes (beta = 0.16, p < 0.05) were independently associated with follow-up infarct volume. The rCBV < 42% lesion volume is independently associated with FLAIR follow-up infarct volume.

Keywords: infarct volume; rCBV < 42%; relative cerebral blood volume.

Grants and funding

This study is supported by the Johns Hopkins University Department of Radiology Physician Scientist Incubator Program (RAD-PSI) to VSY and the Johns Hopkins School of Medicine Physician Scientist Scholar Program to DAL).