# Prediction of stroke recurrence for patients with middle cerebral artery atherosclerotic disease by CT perfusion

## TL;DR

This study shows that CT perfusion can predict stroke recurrence in patients with middle cerebral artery atherosclerosis by measuring hypoperfusion areas.

## Contribution

The study demonstrates that CTP metrics like Tmax>4s and Tmax>6s volumes are novel predictors of stroke recurrence in atherosclerotic disease.

## Key findings

- Patients with larger hypoperfusion areas (Tmax>4s and Tmax>6s) had higher stroke recurrence rates.
- Tmax>4s volume >133.60mL and Tmax>6s volume >17.95mL were optimal cutoffs for predicting recurrence.

## Abstract

This paper aimed to test the feasibility of computed tomography perfusion (CTP) in predicting stroke recurrence in patients with symptomatic middle cerebral artery atherosclerotic disease.

This is a retrospective study. 322 patients from 4 advanced stroke centers diagnosed as symptomatic middle cerebral artery atherosclerotic disease, including severe stenosis and occlusion were recruited. All patients underwent head CTP, digital subtraction angiography (DSA), MR 14-21 days after onset. Stroke recurrence of patients within 3 months was recorded. Patients were divided into recurrence group and control group according to whether stroke recurrence 3 months after onset. The association of imaging characteristics, other risk factors and patients stroke recurrence was assessed.

104 patients presented stroke recurrence within 3 months after onset. Patients in recurrence group showed more severe vascular stenosis (p < 0.001) and presented with larger hypoperfusion area than control group, as shown by larger Tmax>4 s, Tmax>6 s, Tmax>8 s, Tmax>10s volume (p < 0.001). The multiple logistic regression showed that the volume of Tmax>4 s (OR = 1.061 per 10 mL increase, 95% CI: 1.005–1.122, p = 0.033) and Tmax>6 s (OR = 1.265 per 10 mL increase, 95% CI: 1.093–1.483, p = 0.002) at 14–21 days after stroke were strongly associated with stroke recurrence, Tmax>4 s (AUC = 0.76, 95% CI: 0.70 to 0.81, p < 0.001) and Tmax>6 s (AUC = 0.74, 95% CI: 0.68 to 0.81, p < 0.001) volume had a high discriminative ability for a poor outcome. Tmax>4 s volume larger than 133.60 mL being an optimal cutoff (sensitivity = 80.7% and specificity = 58.6%, Youden index = 39.3%) and Tmax>6 s volume larger than 17.95 mL being an optimal cutoff (sensitivity = 83.5% and specificity = 58.7%, Youden index = 42.2%).

Symptomatic middle cerebral artery atherosclerotic stenosis or occlusion patients with severe hypoperfusion might suffer a higher risk of stroke recurrence. Volume of Tmax>4 s and Tmax>6 s in CTP could be used to predict the prognosis of these patients.