Evidence map›Paper›PMID 40557487›Full record

Observational studyStroke2025

Hypodensity Beyond the Ischemic Core: Penumbral Changes Detected With Relative Noncontrast Computed Tomography.

Lieselotte Vandewalle, Praneeta R Konduri, Soren Christensen, Pierre Seners, Anke Wouters, Nicole Yuen, Michael Mlynash, Stephanie Kemp, Jeremy J Heit, Gregory W Albers and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Lieselotte VandewalleNeurology Department, University Hospitals of Leuven, Belgium (L.V., J.D., R.L.).ORCID 0000-0002-0375-3804
Praneeta R KonduriDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0002-9911-2090
Soren ChristensenDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0003-1242-3724
Pierre SenersInstitut de psychiatrie et Neurosciences de Paris, U1266, INSERM, France (P.S.).ORCID 0000-0002-2134-0691
Anke WoutersDivision of Experimental Neurology, Department of Neurosciences, KU Leuven, Belgium (L.V., A.W., J.D., R.L.).ORCID 0000-0001-5229-2699
Nicole YuenDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0003-3206-6656
Michael MlynashDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0001-7483-8699
Stephanie KempDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).
Jeremy J HeitDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0003-1055-8000
Gregory W AlbersDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0003-0263-4632
Jelle DemeestereNeurology Department, University Hospitals of Leuven, Belgium (L.V., J.D., R.L.).ORCID 0000-0001-8186-0237
Maarten G LansbergDepartment of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, Palo Alto, CA (P.R.K., S.C., N.Y., M.M., S.K., J.J.H., G.W.A., M.G.L.).ORCID 0000-0002-3545-6927
Robin LemmensNeurology Department, University Hospitals of Leuven, Belgium (L.V., J.D., R.L.).ORCID 0000-0002-4948-5956

Funding

CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP)R01NS075209 · NINDS · STANFORD UNIVERSITY · PI LANSBERG, MAARTEN G · 2011 to 2023
$6.0M
NINDS NIH HHS R01 NS075209
6 · The paper itself

Abstract

backgroundIn acute ischemic stroke, infarcted tissue gradually becomes detectable on noncontrast computed tomography (NCCT) as a hypodensity representing vasogenic edema. We studied whether subtle NCCT density changes are also present in penumbral tissue.

methodsThis observational cohort study included patients with stroke with anterior circulation occlusions from the CRISP2 study (CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project 2) who were transferred from a primary to a comprehensive stroke center for consideration of endovascular thrombectomy. Patients received baseline NCCT and computed tomography perfusion at the referring hospital and magnetic resonance imaging at the receiving hospital. We created baseline relative NCCT images, which compare voxel density to the corresponding area in the contralateral hemisphere. We analyzed the relative density of rNCCT in the core and penumbra (based on computed tomography perfusion in referring hospitals). We also assessed the correlation between relative density and the degree of hypoperfusion in the penumbra, defined as the time-to-maximum of the tissue residue function. We studied the association between penumbral changes and functional outcomes on the full distribution of the modified Rankin Scale score at 90 days.

resultsFrom the 314 patients, 162 met inclusion criteria with a median (interquartile range) age of 73 (61-83) years, penumbra volume of 78 (52-113) mL, and core volume of 0.6 (0-13.0) mL; 54% were men. The relative density was reduced by a median of 1.8% (

conclusionsIn patients with anterior circulation acute ischemic stroke, we identified relative hypodensity in penumbral tissue on NCCT with potential clinical relevance on 90-day functional outcomes. The hypodensity was more pronounced with increasing hypoperfusion severity.

Indexed as

Brain IschemiaIschemic StrokeTomography, X-Ray ComputedAgedAged, 80 and overCohort StudiesFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedThrombectomybrain infarctioncerebrovascular circulationedemainfarctionischemic stroke

Identifiers

PMID40557487
PMCPMC12243634

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.