• Maxim Mokin, Elad I Levy, Jeffrey L Saver, Adnan H Siddiqui, Mayank Goyal, Alain Bonafé, Christophe Cognard, Reza Jahan, Gregory W Albers, and SWIFT PRIME Investigators.
• From the Department of Neurosurgery, University of South Florida, Tampa (M.M.); Department of Neurosurgery, University at Buffalo, NY (E.I.L., A.H.S.); Department of Neurology, David Geffen School of Medicine (J.L.S.) and Division of Interventional Neuroradiology (R.J.), University of California, Los Angeles; Departments of Radiology and Clinical Neurosciences, University of Calgary, Alberta, Canada (M.G.); Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France (A.B.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, France (C.C.); and Stanford Stroke Center, Stanford University School of Medicine, CA (G.W.A.). maximmokin@gmail.com.
• Stroke. 2017 Apr 1; 48 (4): 932-938.

Background And PurposeComputed tomography perfusion imaging can estimate the size of the ischemic core, which can be used for the selection of patients for endovascular therapy. The relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) thresholds chosen to identify ischemic core influence the accuracy of prediction. We aimed to analyze the accuracy of various rCBV and rCBF thresholds for predicting the 27-hour infarct volume using RAPID automated analysis software from the SWIFT PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment) data.MethodsPatients from the SWIFT PRIME study who achieved complete reperfusion based on time until the residue function reached its peak >6 s perfusion maps obtained at 27 hours were included. Patients from both the intravenous tissue-type plasminogen activator only and endovascular groups were included in analysis. Final infarct volume was determined on magnetic resonance imaging (fluid-attenuated inversion recovery images) or computed tomography scans obtained 27 hours after symptom onset. The predicted ischemic core volumes on rCBV and rCBF maps using thresholds ranging between 0.2 and 0.8 were compared with the actual infarct volume to determine the most accurate thresholds.ResultsAmong the 47 subjects, the following baseline computed tomography perfusion thresholds most accurately predicted the actual 27-hour infarct volume: rCBV=0.32, median absolute error (MAE)=9 mL; rCBV=0.34, MAE=9 mL; rCBF=0.30, MAE=8.8 mL; rCBF=0.32, MAE=7 mL; and rCBF=0.34, MAE=7.3.ConclusionsBrain regions with rCBF 0.30 to 0.34 or rCBV 0.32 to 0.34 thresholds provided the most accurate prediction of infarct volume in patients who achieved complete reperfusion with MAEs of ≤9 mL.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.© 2017 American Heart Association, Inc.

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