Background/Aims
To investigate the association between CT perfusion lesion location and clinical outcomes of acute ischemic stroke.
Methods
Patients with M1 occlusion treated with endovascular thrombectomy were selected from the Liverpool Hospital stroke database, who had baseline CT perfusion scans within 24 hours of stroke onset. Imaging data was processed using MIStar software to segment volumes into white matter (MW) and grey matter (GM) core and penumbra. Clinical outcomes were measured using the modified Rankin Scale (mRS), with good outcome defined as mRS 0-1. Statistical analysis was conducted using t-tests and logistic regression to assess the relationship of lesions and outcome.
Results
37 patients were identified. The mean age was 71 years, and the mean baseline NIHSS was 19. The mean lesion volumes were as follows: WM core 14.8±17.8 mL, WM penumbra 25.8±13.4 mL, GM core 8.1±11.9 mL, and GM penumbra 68.8±23.7 mL. Patients with a good outcome had significantly lower WM core volumes compared to those with poor outcomes (7.4±6.9 vs 19.9±21.2 mL, p=0.034). Logistic regression revealed that higher WM core volumes were associated with lower odds of good outcome, adjusting for age, baseline NIHSS and lesion hemisphere (adjusted odds ratio = 0.89, 95% CI 0.81-0.99, p=0.025). Other lesion volumes (WM penumbra, GM core, GM penumbra) were not significant predictors of a good 3-month outcome.
Conclusion
CTP lesion location, particularly WM core volume, can significantly predict post-stroke outcomes. This highlights the importance of lesion characterisation in acute ischemic stroke management and prognosis.