{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T03:28:25Z","timestamp":1793935705246,"version":"4.8.0"},"reference-count":18,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2022,2,8]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Proper identification of infarct extent is crucial for thrombectomy and prognostication. We sought to study the frequency and topographic aspects of those cases in which CT perfusion (CTP) misses a core lesion that is present on initial non-contrast CT (NCCT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A review was carried out of a prospectively collected database of endovascular patients with anterior circulation large vessel occlusion strokes from January 2014 to November 2018. Patients with an e-ASPECTS &lt;10\u2009and adequate CTP maps were included. Total missed ischemic core (TMC) was defined as a CTP core lesion (relative cerebral blood flow &lt;30%) &lt;1\u2009mL with a visualized hypodensity on NCCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 629 patients were analyzed of which 161 (25.6%) had a TMC. On univariate analysis, TMC was associated with isolated deep middle cerebral artery (MCA) strokes (77.6% vs 56.6%, p&lt;0.001), lower National Institutes of Health Stroke Scale (NIHSS) score (9 (15\u201320) vs 17 (13\u201321), p=0.007) and longer times to treatment (452 (288\u2013652) min vs 355 (236\u2013655) min, p=0.03). After adjusting for identifiable confounders, isolated deep MCA stroke was an independent predictor of TMC (OR 2.49 (95%\u2009CI 1.63 to 3.8), p&lt;0.001). There were no differences between patients presenting with a TMC and those not with good outcomes (modified Rankin Scale 0\u20132) (50.8% vs 47.6%, p=0.53) or 90-day mortality (23% vs 17.6%, p=0.17). However, TMC was associated with lower rates of any parenchymal hematomas (5.2% vs 14.6%, p=0.02; aOR 0.11 (95%\u2009CI 0.01 to 0.91), p=0.04) and smaller final infarct volumes (20.5\u2009(11.3\u201342.9) mL vs 47.5 (20.3\u201385) mL, p&lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CTP may completely fail to detect ischemic core in as many as 25% of cases, especially in isolated deep MCA strokes. Technical refinements of the post-processing algorithms are therefore warranted. TMC infarcts may have a lower risk of reperfusion hemorrhage, potentially due to greater preservation of the neurovascular unit structure in face of delayed recovery of cerebral blood flow.<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2021-018490","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T18:25:24Z","timestamp":1646936724000},"page":"183-187","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Falsely normal CT perfusion ischemic core readings are common and often associated with deep infarcts"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1601-5912","authenticated-orcid":false,"given":"Mehdi","family":"Bouslama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan","family":"Ravindran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9152-0882","authenticated-orcid":false,"given":"Gabriel Martins","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0300-6355","authenticated-orcid":false,"given":"Leonardo","family":"Pisani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo C","family":"Haussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Frankel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G","family":"Nogueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"2024052307034227000_15.2.183.1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"2024052307034227000_15.2.183.2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015636"},{"key":"2024052307034227000_15.2.183.3","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2016-012494"},{"key":"2024052307034227000_15.2.183.4","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X15610586"},{"key":"2024052307034227000_15.2.183.5","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1161\/STROKEAHA.118.023177","article-title":"Ischemic core and hypoperfusion volumes correlate with infarct size 24 hours after randomization in DEFUSE 3","volume":"50","author":"Rao","year":"2019","journal-title":"Stroke"},{"key":"2024052307034227000_15.2.183.6","doi-asserted-by":"crossref","DOI":"10.1126\/science.aax7171","article-title":"Cerebrospinal fluid influx drives acute ischemic tissue swelling","volume":"367","author":"Mestre","year":"2020","journal-title":"Science"},{"key":"2024052307034227000_15.2.183.7","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2012-303752"},{"key":"2024052307034227000_15.2.183.8","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4904"},{"key":"2024052307034227000_15.2.183.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2016.01.001"},{"key":"2024052307034227000_15.2.183.10","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7461\/jcen.2020.22.1.8","article-title":"Discrepancy in core infarct between non-contrast CT and CT perfusion when selecting for mechanical thrombectomy","volume":"22","author":"John","year":"2020","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"key":"2024052307034227000_15.2.183.11","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015472"},{"key":"2024052307034227000_15.2.183.12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/9853837","article-title":"Elderly stroke rehabilitation: overcoming the complications and its associated challenges","volume":"2018","author":"Lui","year":"2018","journal-title":"Curr Gerontol Geriatr Res"},{"key":"2024052307034227000_15.2.183.13","first-page":"231","article-title":"[Regional cerebral blood flow of the basal ganglia and thalamus measured using Xe-CT]","volume":"52","author":"Haku","year":"2000","journal-title":"No To Shinkei"},{"key":"2024052307034227000_15.2.183.14","first-page":"905","article-title":"Simultaneous measurement of regional cerebral blood flow by perfusion CT and stable xenon CT: a validation study","volume":"22","author":"Wintermark","year":"2001","journal-title":"AJNR Am J Neuroradiol"},{"key":"2024052307034227000_15.2.183.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000217258.63925.6b"},{"key":"2024052307034227000_15.2.183.16","doi-asserted-by":"publisher","DOI":"10.1007\/s003300000707"},{"key":"2024052307034227000_15.2.183.17","doi-asserted-by":"publisher","DOI":"10.1177\/1747493016632244"},{"key":"2024052307034227000_15.2.183.18","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s00234-020-02533-6","article-title":"Validation of automated Alberta Stroke Program Early CT score (ASPECTS) software for detection of early ischemic changes on non-contrast brain CT scans","volume":"63","author":"Wolff","year":"2021","journal-title":"Neuroradiology"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2021-018490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T14:06:36Z","timestamp":1716473196000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2021-018490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1,11]]},"published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1136\/neurintsurg-2021-018490"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2021-018490","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]}}}