Defining Large Core Infarction: Comparing the Accuracy of Non-Contrast CT ASPECTS Versus CT Perfusion Core Volume

Authors

• Ngoc Mai Le
• Joseph Samaha
• Ananya S Iyyangar
• Javier Gomez-Farias
• Bruna Kfoury
• Ritesh Bajaj
• Connor Nguyen
• Syed Shams
• Camille Neal-Harris
• Emmanuel Ebirim
• Hussain Azeem
• Anjan N Ballekere
• Saagar Dhanjani
• Eunyoung Lee
• Luca Giancardo
• Sunil A Sheth

Language

English

Publication Date

1-1-2026

Journal

Journal of Neuroimaging

DOI

10.1111/jon.70130

PMID

41744175

PMCID

PMC12937044

PubMedCentral® Posted Date

2-26-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background and purpose: We evaluated agreement and performance of non-contrast head-computerized tomography (NCHCT) and CT-perfusion (CTP) in identifying large core infarct in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing endovascular therapy (EVT), using MRI as reference.

Methods: From our prospective multicenter registry, we identified patients with LVO-AIS due to internal carotid artery or middle cerebral artery M1occlusions who underwent EVT between 2017 and 2024. Final infarct volume (FIV) was defined using 24-48 h post-EVT diffusion-weighted imaging magnetic resonance imaging (MRI-FIV). To limit infarct growth bias, only patients with CTP-to-EVT start time < 3 h were included. Large core infarct was defined at FIV thresholds: 50, 70, and 100 mL. The primary outcome was agreement between NCHCT and CTP in identifying large core infarct using kappa-statistics. Large core was considered if NCHCT-ASPECTS< 6 or rCBF< 30% volume>70 mL on CTP (RAPID/Viz.AI). Secondary outcomes included classification accuracy of each modality relative to MRI-FIV using the area under the receiver operating characteristic curve (AUC-ROC). Sensitivity analyses were performed in subgroups with TICI 2c-3 and cases processed by RAPID.

Results: Among 241 EVT-treated LVO-AIS patients, median NIHSS was 15 [IQR: 10-20], MRI-FIV 13.8 Ml [IQR: 5-41.0], ASPECTS 8 [IQR: 7-10], and CTP-predicted core 8 mL [IQR: 0-31.0]. CTP and NCHCT showed slight agreement in identifying large core (κ = 0.192) and weak-to-acceptable discrimination for identifying large core infarcts (AUC-ROC: 0.61-0.72 across MRI-FIV thresholds). Both modalities showed limited predictive ability for 90-day functional independence (AUC-ROC: 0.63-0.65). Similar findings were observed in sensitivity analyses.

Conclusions: Among LVO-AIS EVT-treated patients, NCHCT and CTP demonstrated slight agreement in classifying small versus large core, and neither technique was effective at predicting FIV or clinical outcomes.

Keywords

ASPECTS, CT perfusion, large core infarction

Published Open-Access

yes

Recommended Citation

Le, Ngoc Mai; Samaha, Joseph; Iyyangar, Ananya S; et al., "Defining Large Core Infarction: Comparing the Accuracy of Non-Contrast CT ASPECTS Versus CT Perfusion Core Volume" (2026). Faculty, Staff and Student Publications. 3817.
https://digitalcommons.library.tmc.edu/uthmed_docs/3817