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Purpose <p>While CT perfusion (CTP) is the current standard for endovascular thrombectomy (EVT) selection in extended time windows with acute ischemic stroke with large vessel occlusion (LVO-AIS), the added prognostic value of CTP over non-contrast CT (NCCT)-based models remains debated, particularly when combined with clinical variables.</p> Methods <p>In this dual-center retrospective cohort study, we analyzed 216 consecutive anterior circulation LVO-AIS patients undergoing EVT between May 2021 and March 2024. Univariate and multivariate analysis were performed on both NCCT-derived and CTP-derived imaging parameters alongside clinical variables, with 90-day functional independence (modified Rankin Scale [mRS] 0–2) as primary endpoint. The ROC curves of the two models were computed using 5-fold cross-validation, and differences in the area under the curve (AUC) were evaluated using DeLong’s test.</p> Results <p>Functional independence (mRS 0–2) was achieved in 42.6% (92/216) of the patients. The NCCT-clinical model incorporated ASPECTS, baseline NIHSS and diabetes status, and the CTP-clinical model incorporated ischemic core volume, baseline NIHSS and diabetes status. The NCCT-clinical model demonstrated AUC of 0.819 and the CTP-clinical model 0.834. The difference of AUC showed no statistical significance​ between NCCT-clinical model and the CTP-clinical model (ΔAUC = 0.015, <i>P</i> = 0.964). The NCCT-clinic model demonstrated comparable performance to CTP-clinic model, including accuracy (74.0% vs. 75.8%), sensitivity (80.5% vs. 82.1%) and specificity (65.7% vs. 67.7%). </p> Conclusion <p>The NCCT-clinical model achieved comparable ability to predict prognosis compared to the CTP-clinical model in extended time windows with LVO-AIS.</p>

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Non-Contrast CT versus CT perfusion for predicting post-thrombectomy outcomes in anterior circulation large vessel occlusion stroke

  • 期刊论文

  • 发表日期：

    2025年10月28日

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  • Yuan Ma,
  • Yifu Liu,
  • Minqiang Tang,
  • Xinglong Liu,
  • Guangdong Lu,
  • Kai Qiu:,
  • Chun Zhou,
  • Linbo Zhao,
  • Yuezhou Cao,
  • Sheng Liu,
  • Haibin Shi,
  • Zhenyu Jia

摘要

Purpose

While CT perfusion (CTP) is the current standard for endovascular thrombectomy (EVT) selection in extended time windows with acute ischemic stroke with large vessel occlusion (LVO-AIS), the added prognostic value of CTP over non-contrast CT (NCCT)-based models remains debated, particularly when combined with clinical variables.

Methods

In this dual-center retrospective cohort study, we analyzed 216 consecutive anterior circulation LVO-AIS patients undergoing EVT between May 2021 and March 2024. Univariate and multivariate analysis were performed on both NCCT-derived and CTP-derived imaging parameters alongside clinical variables, with 90-day functional independence (modified Rankin Scale [mRS] 0–2) as primary endpoint. The ROC curves of the two models were computed using 5-fold cross-validation, and differences in the area under the curve (AUC) were evaluated using DeLong’s test.

Results

Functional independence (mRS 0–2) was achieved in 42.6% (92/216) of the patients. The NCCT-clinical model incorporated ASPECTS, baseline NIHSS and diabetes status, and the CTP-clinical model incorporated ischemic core volume, baseline NIHSS and diabetes status. The NCCT-clinical model demonstrated AUC of 0.819 and the CTP-clinical model 0.834. The difference of AUC showed no statistical significance​ between NCCT-clinical model and the CTP-clinical model (ΔAUC = 0.015, P = 0.964). The NCCT-clinic model demonstrated comparable performance to CTP-clinic model, including accuracy (74.0% vs. 75.8%), sensitivity (80.5% vs. 82.1%) and specificity (65.7% vs. 67.7%).

Conclusion

The NCCT-clinical model achieved comparable ability to predict prognosis compared to the CTP-clinical model in extended time windows with LVO-AIS.