Computed tomography perfusion in acute ischemic stroke: correlation of perfusion findings with follow-up imaging after intravenous thrombolysis
Keywords:
acute ischemic stroke, CT perfusion, infarct core, penumbra, thrombolysisAbstract
Background: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide, characterized by a sudden interruption of cerebral blood flow and rapid neuronal injury. Early differentiation between the infarct core and ischemic penumbra is critical for appropriate therapeutic decision-making. Aim: To evaluate the role of computed tomography perfusion (CTP) imaging in evaluating brain tissue viability and predicting imaging outcomes after intravenous thrombolytic therapy in patients with acute ischemic stroke. Materials and Methods: Four representative patients with acute ischemic stroke who underwent CT perfusion imaging prior to intravenous thrombolysis at Heart and Brain Hospital, Burgas, were retrospectively reviewed. Perfusion parameters, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to maximum (Tmax) were analyzed and correlated with 24-hour follow-up CT findings. Results: Patients with a predominance of ischemic penumbra and minimal infarct core demonstrated favorable imaging outcomes after thrombolysis, whereas large infarct cores were associated with extensive infarction or hemorrhagic transformation on follow-up imaging. Conclusion: CT perfusion is a valuable tool in the diagnostic and therapeutic workflow of acute ischemic stroke, allowing individualized treatment strategies and improving clinical outcomes through the precise identification of viable brain tissue.
References
Campbell BCV, De Silva DA, Macleod MR, et al.: Ischaemic stroke. Nat Rev Dis Primers. 2019, 5:70. doi:10.1038/s41572-019-0118-8
Feigin VL, Stark BA, Johnson CO, et al.: Global, regional, and national burden of stroke and its risk factors, 1990- 2019. Lancet Neurol. 2021, 20:795-820. doi:10.1016/S1474- 4422(21)00252-0
World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025.
Powers WJ, Rabinstein AA, Ackerson T, et al.: Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2019, 50:e344-e418. doi:10.1161/STR.0000000000000211
Barber PA, Demchuk AM, Zhang J, Buchan AM: Validity and reliability of a quantitative CT score in predicting outcome of hyperacute stroke (ASPECTS). Lancet. 2000, 355:1670-1674. doi:10.1016/S0140-6736(00)02237-6
Konstas AA, Goldmakher GV, Lee TY, Lev MH: Theoretical basis and technical implementations of CT perfusion in acute ischemic stroke. AJNR Am J Neuroradiol. 2009, 30:662-668. doi:10.3174/ajnr.A1487
Saver JL: Time is brain—quantified. Stroke. 2006, 37:263-266. doi:10.1161/01.STR.0000196957.55928.ab
Christensen S, Lansberg MG. CT perfusion in acute stroke: practical guidance for implementation in clinical practice. J Cereb Blood Flow Metab. 2019;39(9):1664-1668. doi:10.1177/0271678X18805555
Albers GW, Marks MP, Kemp S, et al.: Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018, 378:708-718. doi:10.1056/NEJMoa1713973
Campbell BCV, Christensen S, Levi CR, et al.: Comparison of imaging software for ischemic core and penumbra estimation. Stroke. 2011, 42:1534-1540. doi:10.1161/STROKEAHA.110.610618
Nogueira RG, Jadhav AP, Haussen DC, et al.: Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018, 378:11-21. doi:10.1056/NEJMoa1706442
Albers GW: Late window paradox in stroke treatment. Stroke. 2018, 49:768-770. doi:10.1161/STROKEAHA.118.020008
Munich SA, Shakir HJ, Snyder KV. Role of CT perfusion in acute stroke management. Cor Vasa. 2016;58(2). doi:10.1016/j.crvasa.2016.01.008
Wintermark M, Albers GW, Alexandrov AV, et al.: Acute stroke imaging research roadmap II. Stroke. 2013, 44:2628-2639. doi:10.1161/STROKEAHA.113.002015
Halil E, Atanassova B, Hristova M, Chompalov K, et al. Computed tomography perfusion as a method for selection of potential candidates for intravenous thrombolysis in acute ischemic stroke – presentation of clinical cases. Bulgarian Neurology.2023;24(1):36-39.
Llinas EJ, Max A, Khan S, Marsh EB. The routine followup head CT: is it still a necessary step in the thrombolysis pathway? Front Neurol. 2021;12:769812. doi:10.3389/ fneur.2021.769812
Wesolowski R, Blockley NP, Driver ID, et al. Coupling between cerebral blood flow and cerebral blood volume: contributions of different vascular compartments. J Cereb Blood Flow Metab. 2019;39(11):2124-2136. doi:10.1177/0271678X18814956
Campbell BCV, Ma H, Ringleb PA, et al.: EXTEND trial: thrombolysis guided by perfusion imaging. N Engl J Med. 2019, 380:1795-1803. doi:10.1056/NEJMoa1813046
Greenberg ED, Gobin YP, Riina H, et al. Role of CT perfusion imaging in the diagnosis and treatment of vasospasm. Imaging Med. 2011;3(3):287-297. doi:10.2217/iim.11.23
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