Value of pre-intervention computed tomography perfusion imaging in the assessment of tissue outcome and long-term clinical prognosis in patients with anterior circulation acute ischemic stroke receiving reperfusion therapy: a systematic review

Acta Radiol. 2022 Sep;63(9):1243-1254. doi: 10.1177/02841851211035892. Epub 2021 Aug 3.


Background: Computed tomography perfusion (CTP) imaging has emerged as an important adjunct to the current armamentarium of acute ischemic stroke (AIS) workflow. However, its adoption in routine clinical practice is far from optimal.

Purpose: To investigate the putative association of CTP imaging biomarkers in the assessment of prognosis in acute ischemic stroke.

Material and methods: We performed a systematic review of the literature using MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials focusing on CTP biomarkers, tissue-based and clinical-based patient outcomes. We included randomized controlled trials, prospective cohort studies, and case-controlled studies published from January 2005 to 28 August 2020. Two independent reviewers conducted the study appraisal, data extraction, and quality assessment of the studies.

Results: A total of 60 full-text studies were included in the final systematic review analysis. Increasing infarct core volume is associated with reduced odds of achieving functional independence (modified Rankin score 0-2) at 90 days and is correlated with the final infarct volume when reperfusion is achieved.

Conclusion: CTP has value in assessing tissue perfusion status in the hyperacute stroke setting and the long-term clinical prognosis of patients with AIS receiving reperfusion therapy. However, the prognostic use of CTP requires optimization and further validation.

Keywords: Acute ischemic stroke; biomarkers; computed tomography perfusion; functional outcomes; reperfusion therapy.

Publication types

  • Systematic Review

MeSH terms

  • Brain Ischemia* / diagnostic imaging
  • Brain Ischemia* / therapy
  • Humans
  • Infarction
  • Ischemic Stroke* / diagnostic imaging
  • Ischemic Stroke* / therapy
  • Perfusion Imaging / methods
  • Prognosis
  • Prospective Studies
  • Reperfusion
  • Stroke* / diagnostic imaging
  • Stroke* / therapy
  • Tomography, X-Ray Computed / methods