Responses

PDF
Case series
Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]
Publication Date - String

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Reduction of ghost infarct core with TMax/CBF mismatch in CT perfusion
    • Leonardo Renieri, Interventional neuroradiologist NNeurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
    • Other Contributors:
      • Salvatore Mangiafico, Interventional neuroradiologist
      • Enrico Fainardi, Diagnostic neuroradiologist

    TO THE EDITOR: We read with interest the recent paper by Boned and colleagues.1 The authors conclude that “CT perfusion may overestimate final infarct core, especially in the early time window. Selecting patients for reperfusion therapies based on the CTP mismatch concept may deny treatment to patients who might still benefit from reperfusion”. We completely agree with this consideration, mainly when, as in this article, the core volume is assessed according to the classical CT perfusion (CTP) mismatch mean transit time (MTT)/cerebral blood volume (CBV)2 by measuring the lesion on CBV maps generated with a one-phase CT perfusion (CTP) acquisition protocol. In fact, it is well-known that a short CTP scan duration often produces a truncation of the perfusion curves resulting in an overestimation of CBV lesion that can frequently reverse.3 In addition, it has recently been demonstrated that relative cerebral blood flow (CBF) < 30% and time to peak of the residual function (Tmax) > 6 seconds is more reliable than CBV < 2.0 ml/100gr and relative MTT > 145% in identifying infarct core and ischemic penumbra at admission, respectively.4,5 As a consequence, the new CTP mismatch model Tmax/CBF was successfully used to include acute ischemic stroke (AIS) patients in the last trials showing the efficacy of endovascular treatment.6-9 We recently treated with combined intravenous thrombolysis and with mechanical thrombectomy patients imaged within 1.5 hour from symptom onset...

    Show More
    Conflict of Interest:
    None declared.
  • Published on:
    Trying to catch the "ghost ischemic core": CT perfusion versus DWI
    • Nicola Morelli, MD
    • Other Contributors:
      • Eugenia Rota, Emanuele Michieletti and Donata Guidetti

    Dear Editor, We read with great interest the original article by Boned S. et al. (1) which demonstrates that CT perfusion (CTP) may overestimate the final infarct core, especially in the early time window. Interestingly, the authors introduce the "ghost infarct core" concept in ischemic stroke, referring to that particular condition where the final infarct core at follow up imaging may be smaller than the one observed on...

    Show More
    Conflict of Interest:
    None declared.