CT-Perfusion absolute Ghost Infarct Core is a rare phenomenon associated with poor collateral status in acute ischemic stroke patients

Abstract

ABSTRACTBackgroundCT-Perfusion (CTP) overestimation of core volume >10 mL compared to the final infarct volume (FIV) size is the current definition of the ghost infarct core (GIC) phenomenon. However, subsequent infarct growth might influence FIV. We aimed to report a more reliable assessment of GIC occurrence, defined as the lack of FIV at 24 hours follow-up imaging, compared to CTP core volume at admission. This phenomenon was named absolute GIC (aGIC) and we investigated its prevalence and predictors.MethodsA total of 652 consecutive stroke patients with large vessel occlusion who achieved successful recanalization (mTICI 2b-3) after Endovascular Treatment (EVT) and non-contrast CT (NCCT) follow-up imaging at 24 hours were retrospectively analyzed. Ischemic core volume was automatically generated from CTP, and FIV was manually determined on follow-up NCCT. Multivariable logistic regression was used to explore aGIC predictors.ResultsWe included 652 patients (53.3% female, median age 75 years), of whom 35 (5.3%) had an aGIC. The aGIC group showed higher ASPECTS (p<0.001), shorter (<3 hours) onset-to-imaging time (p<0.001), poorer collaterals (p<0.001), higher hypoperfusion intensity ratio (p=0.001) compared to the non-aGIC group. In multivariate analysis, ASPECTS (odds ratio [OR], 1.87; p<0.001), onset-to-imaging time (OR, 0.99; p=0.013), collateral score (OR, 0.45; p<0.004) and hypoperfusion intensity ratio (OR, 23.2; p<0.001) were independently associated with aGIC.ConclusionaGIC is a more reliable evaluation of infarct core volume overestimation assessed on admission CTP and represents a rare phenomenon, associated with ultra-early presentation and poor collaterals.