Observational studyNeuroradiology2025
Predictor value of pCASL maps on final core in acute ischemic stroke: an observational single‑center study.
Observational study in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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18 authors.
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Abstract
purposeThe three-compartment model of acute ischemic stroke (AIS) includes non-viable tissue (NVT), tissue at risk (TAR), and benign oligoemia. After assessing a multimodal computed tomography (CT)-based protocol, we assessed a hyperacute stroke imaging protocol with magnetic resonance imaging (MRI), aiming to better characterize the reliability of the two methods in predicting follow-up infarction.
methodsWe retrospectively reviewed 627 consecutive AIS patients evaluated for the selection for reperfusive treatments at comprehensive stroke center. We employed an MRI-based protocol for proper patient selection, including pseudocontinuous arterial spin labeling (pCASL) and diffusion-weighted imaging (DWI). To assess prognostic accuracy of pCASL maps in predicting final infact, we assumed the best correlation between NVT and final infarct in patients with favorable clinico-radiological outcomes. On the other hand, the TAR should better correlate with final infarct in untreated patients and in treatment failure.
resultsWe recruited 349 patients undergoing MRI-based protocol with DWI and pCASL, showing diagnostic accuracy of 84.8%. In anterior circulation perfusion deficit, DWI was highly reliable for NVT in patients with favorable clinical-instrumental outcomes. PCASL tended to overestimate TAR in patients with unfavorable outcome, but the rate of complete overlap with the final infarct was high. The previously assessed CT-based protocol showed a lower prognostic accuracy, as the CT-perfusion using time-to-maximum overestimated both the NVT and the TAR.
conclusionsWe found a highly reliable prognostic accuracy for DWI-pCASL. Even if pCASL proved reliable to identify the area of total hypoperfusion, there was an overestimation of TAR in many cases, with a tendency to incorporate the benign oligoemia.
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