Association of CT Perfusion Parameters with Hemorrhagic Transformation in Acute Ischemic Stroke

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Fig 1.
CTP maps. A, volume at risk of ischemia (volume computed from the area and thickness of each section [5 mm]). B, MTT. C, CBF. D, CBV. CTP images of a patient with AIS with right MCA occlusion. rMTT, rCBF, and rCBV are computed by normalizing MTT, CBF, and CBV of the ischemic area to the contralateral normal side. The outlined region of interest shows increased MTT, decreased CBF, and preserved CBV in each respective panel.
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Fig 2.
ROC curve of rCBV in patients with and without HT, excluding all patients receiving endovascular therapy (7 cases [accounting for 13 controls] and 1 additional control who received endovascular therapy were excluded). rCBV represents CBV of the ischemic area normalized to the contralateral side. The cutoff point indicates the threshold at which rCBV can predict HT with optimal sensitivity and specificity.
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Fig 3.
ROC curve of rCBV in patients with and without HT (excluding cases with both endovascular therapy and PH/SAH [n = 1] and their corresponding controls [n = 2]). rCBV represents CBV of the ischemic area normalized to the contralateral side. The cutoff point indicates the threshold at which rCBV can predict HT with optimal sensitivity and specificity.

Table 1:

Characteristics of study cohort

Characteristics	Total Patients (n = 83)
Female (No.) (%)	37 (44.6%)
Age (yr) (median) (IQR)	72 (61–80)
Time (min) to arrival (median) (IQR)	124 (64–314)
Stroke severity on arrival (NIHSS) (median) (IQR)	7 (3–15)
Medical history
Hypertension	77.8%
Diabetes	26.8%
Dyslipidemia	52.4%
Stroke/TIA	34.9%
Coronary artery disease	24.4%
Medication history
Antiplatelets	45.0%
Anticoagulants	10.1%
Thrombolysis done	27.7%
Functional outcome (mRS) at discharge (median) (IQR)	3 (1–5)
Duration (days) of hospital stay (median) (IQR)	5 (3–8)

Table 2:

Comparison of cases and controls (matched on IV rtPA and NIHSS ± 2)

Characteristics	Cases (n = 14)	Controls (n = 38)	P Value
Age (yr) (median) (IQR)	71 (61–77)	75 (65–84)	.15
Female (No.) (%)	4 (28.6%)	19 (50.0%)	.22
Time (min) to arrival (median) (IQR)	127.5 (25–391)	134 (67–547)	.23
Arrival systolic BP (mm Hg) (median) (IQR)	146.5 (136–171)	153 (134–162)	.87
Arrival diastolic BP (mm Hg) (median) (IQR)	81.5 (75–98)	83 (66–102)	.74
Arrival glucose level (mg/dL) (median) (IQR)	123.5 (107–141)	120.5 (104–142)	.85
Arrival INR (median) (IQR)	1 (1–1.1)	1.1 (1–1.2)	.15
Medical history
Hypertension	85.7%	75.0%	.71
Diabetes	21.4%	29.7%	.73
Dyslipidemia	57.1%	54.1%	.84
Stroke/TIA	35.7%	29.7%	.68
Coronary artery disease	42.9%	16.2%	.05
Antiplatelet use	50%	38.9%	.48
Smoking	43.2%	27.0%	.20

Table 3:

Comparison of CTP parameters for matched cases and controls after excluding patients having undergone endovascular therapy^a

Parameter	Cases (n = 7)	Controls (n = 24)	P Value
MTTv (median) (IQR)	209.6 (48.5–345.6)	147.6 (78.53–235.8)	.5548
Mean ± SD	194.91 (136.98)	161.59 (115.19)
rMTT (median) (IQR)	1.83 (1.42–2.23)	1.80 (1.50–2.16)	.8873
Mean ± SD	1.87 (0.43)	2.20 (1.70)
rCBF (median) (IQR)	0.54 (0.40–0.63)	0.58 (0.46–0.70)	.5079
Mean ± SD	0.52 (0.14)	0.58 (0.15)
rCBV (median) (IQR)	0.92 (0.83–1.07)	1.11 (1–1.29)	.0093^b
Mean ± SD	0.93 (0.13)	1.19 (0.36)

Note:—MTTv indicates volume at risk of ischemia.
↵a Seven cases (accounting for 13 controls) and 1 additional control who received endovascular therapy were excluded.
↵b Statistically significant (P < .05).

Table 4:

Comparison of CTP parameters for matched cases and controls^a

Parameter	Cases (n = 13)	Controls (n = 36)	P Value
MTTv (median) (IQR)	234.9 (178.2–326.15)	183.55 (84.83–265.83)	.1968
Mean ± SD	233.32 (111.53)	186.61 (116.72)
rMTT (median) (IQR)	2.06 (1.69–2.39)	1.8 (1.55–2.17)	.4020
Mean ± SD	2.00 (0.40)	2.16 (1.42)
rCBF (median) (IQR)	0.45 (0.39–0.59)	0.53 (0.42–0.70)	.2572
Mean ± SD	0.48 (0.12)	0.54 (0.16)
rCBV (median) (IQR)	0.92 (0.78–1.03)	1.09 (0.97–1.17)	.0037^b
Mean ± SD	0.92 (0.17)	1.13 (0.33)

Note:—MTTv indicates volume at risk of ischemia.
↵a Excluding cases with both endovascular therapy and SAH/PH (n = 1) and their corresponding controls (n = 2).
↵b Statistically significant (p < .05).