To evaluate the impact of CT perfusion in clinical outcome of patients with acute ischemic stroke, who undergo endovenous thrombolysis and evaluate if perfusion maps may guide the fibrinolytic treatment.

153 patients (79 females, 74 males; average age 76 yo) with acute ischemic stroke of the anterior circulation were included in the study. All patients underwent within 4.5 hours from clinical onset, unenhanced CT, CT angiography and CT perfusion and a CT follow-up after 24-48 hours. Perfusion images were retrospectively evaluated by two radiologists and divided into 6 categories of perfusion scenarios: 0: no perfusion deficit 1: only penumbra 2: penumbra>core 3: penumbra=core 4: penumbra<core 5: only core All patients were clinically evaluated with the...

The distribution of the patients in the different groups is illustrated in Figure 2. The majority of patients were in the groups 0 (Fig 3) and 2 (Fig 4) followed by the groups 1 and 4 (Fig 5). Most of them (67%), underwent endovenous thrombolysis (Fig 6). A positive and statistically significant correlation (rs=.453, p<.001), between CT findings and NIHSS at admission (Fig 7), was found, while a low but positive statistically significant correlation, was observed between CT findings and NIHSS (rs=.367, p<.001) (Fig 7)...

From literature we already know that: - CT perfusion is useful in the selection of patients who have to undergo endovenous thrombolysis before and after 4.5 hours [1,2] - CT perfusion has a higher sensitivity, compared to unenhanced CT and CT angiography[3] - CT perfusion strenghtens the findings of unenhanced CT for the selection of patients suitable for thrombolysis [4,5] - A selection of patients to treat with the data obtained with CT perfusion could bring benefits and a reduction of costs [6]. Our study...

Dr. Roberta Pozzi Mucelli, Dr. Antonio Purpuri, Dr. Maja Ukmar and Prof. Maria Assunta Cova Struttura Complessa di Radiologia Dipartimento di Scienze Mediche, Chirurgiche e della Salute Università degli Studi di Trieste Dr. Giovanni Furlanis Struttura Complessa di Neurologia Dipartimento di Scienze Mediche, Chirurgiche e della Salute Università degli Studi di Trieste

1.Hopyan J, Ciarallo A, Dowlatshahi D et al. Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography. Radiology 2010; 255(1):142-53. 2. Ryu WHA, Avery MB, Dharampal N et al. Utility of perfusion imaging in acute stroke treatment: a systematic review and meta-analysis. J Neurointerv Surg 2017; 9(10): 1012-1016 3. Lin K, Rapalino O, Law M et al. Accuracy of the Alberta Stroke Program Early CT Score during the first 3 hours of middle cerebral artery stroke: comparison of nonconstrast...