Ghost Core Infarct on CTP – Is It Real?

Rotem Sivan-Hoffman 1,2 Firas Sarour 2 Eitan Abergil 1 Gregory Telman 3 Ayelet Eran 2
1Interventional neruoradiologoy, Rambam Healthcare campus, Israel
2Radiology, Rambam Healthcare Campus, Israel
3Neurology, Rambam Healthcare Campus

BACKGROUND: In the setting of extended time window for endovascular treatment (EVT) regarding acute stroke patients, CT Perfusion (CTP) has become a major tool in the decision making. However, there are some fragmented data suggesting that the initial ischemic core may be overestimated by CTP depending on stroke onset time (being referred in prior publications as Ghost Infarct Core, GIC). This study aims to examine whether the phenomenon of GIC does exist and if so, is it time dependent.

METHODS: We studied all consecutive stroke patients undergoing EVT during 2017 who underwent CTP at admission and successful subsequent recanalization. Admission infarct core was measured on Cerebral Blood Volume maps generated using the Intellispace Portal (Philips Healthcare, Best, Netherlands) and final infarct measurement on noncontract follow up CT at 24 hours. We defined ghost infarct core (GIC) as initial core minus final infarct >10 mL.

RESULTS: Out of 107 patients undergoing EVT in the study time, 60 were both anterior circulation and had CTP done in our institute, and of them 34 were compatible with inclusion criteria (known time of onset, no hemorrhagic conversion and good recanalization). Recanalization rate (TICI 2b-3) was 77%. Median National Institutes of Health Stroke Scale score on admission was 13. Median time from symptoms to CTP was 148 min. 17 patients (50%) were found to have GIC. GIC correlated with 180 min time cut off from the stroke onset to CTP (16 patients vs 1, p<0.05).

CONCLUSION: We found the phenomenon of GIC to be real and time dependent.

Rotem Sivan-Hoffmanm
Rotem Sivan-Hoffmanm