Adeola Olowu, MD
Amukotuwa S, Straka M, Aksoy D, Fischbein N, Desmond P, Albers G, et al. Cerebral Blood Flow Predicts the Infarct Core: New Insights From Contemporaneous Diffusion and Perfusion Imaging. Stroke. 2019;50:2783–2789.
The purpose of this study was to assess if cerebral blood flow (CBF) from perfusion studies could accurately estimate infarct core size in ischemic stroke patients during acute stroke management for appropriate thrombectomy triage. Relative cerebral blood flow (rCBF) accuracy would be determined by comparing infarct size to DWI of MRI.
Imaging data was assessed from the DEFUSE 2 and SENSE 3 studies. DEFUSE 2 (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evaluation) evaluated if MRI can be used to determine which patients would most likely benefit from endovascular reperfusion. SENSE 3 (Sensitivity Encoding) compared DWI and CT perfusion to reliably detect ischemic core tissue, at risk tissue, and tissue at risk of hemorrhagic transformation. Between the two studies, 119 patients had both DWI and perfusion studies within 24 hours of symptoms onset.
Relative CBF (rCBF) was divided into 12 thresholds (0.20-0.44), and each of those thresholds were compared to the corresponding DWI. rCBF threshold of 0.32 provided the best prediction of infarct core estimate with DWI. When applying an infarct core limit of 70 mL for thrombectomy, approximately 94% of patients were correctly triaged to the appropriate therapy.