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Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept
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  • 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...

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    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...

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    Conflict of Interest:
    None declared.