Role of computed tomography perfusion in early evaluation of acute cerebral ischemia

Abstract

Background: CT perfusion (CTP) is well-established equipment that is utilized for assessment of cerebral parenchyma viability, which had a crucial role in the evaluation and management of acute stroke. CTP allows for distinction between salvageable ischemic tissues of the brain, known as the “penumbra”, and irreversibly damaged infarcted brain tissue, referred to as the “infarct core”. Methods: This is a prospective study which was conducted on 36 patients with stroke symptom onset within 24 hours (Acute ischemic stroke; AIS). Patients were evaluated with non-enhanced CT to exclude hemorrhage; CTP was performed after exclusion of hemorrhage. Based on imaging, endovascular intervention was scheduled for patients with persistent dysfunction, large vessels occlusion and with salvageable brain tissue as detected by the DWI & perfusion CT scans. NIHSS, ASPECTS& mRS scores were used to assess stroke severity. Results: CTP had high sensitivity (88%) with 95% confidence interval (0.69-0.97) and high specificity (100%) with 95% confidence interval (0.71-0.1). CT perfusion infract volume was associated with good functional outcomes in univariate analysis (OR, 0.93; 95% CI, 0.91-0.99; p=0.002) and remained a significant predictor in multivariable analysis after age, NIHSS, hypertension, diabetes mellitus had adjusted (OR: 0.93; 95% CI: 0.91-0.99; P= 0.03). Conclusion: It is suggested that the application of CTP as an adjunct test may provide some benefits in enhancing the certainty associated with the administration of stroke treatment. Furthermore, the recognized significance of employing imaging criteria in identification of individuals with AIS who get advantages from endovascular revascularization has been demonstrated.