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. 2023 Sep 7:14:1244014.
doi: 10.3389/fneur.2023.1244014. eCollection 2023.

Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA

Shushu Liu  1   2 , Ting Chen  1 , Wei Wu  1
Affiliations

Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA

Shushu Liu et al. Front Neurol. .

Abstract

Objective: To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA).

Methods: A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model.

Results: Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 (p > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant.

Conclusion: The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.

Keywords: ABCD3 score; CT perfusion; secondary cerebral infarction; transient ischemic attack; whole brain.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study profile. CT, computed tomography; TIA, transient ischaemic attack; WB-CTP, whole brain CT perfusion.
Figure 2
Figure 2
An adult patient with TIA presented with secondary cerebral infarction within 90 days of follow-up. (A–D) CTP maps, including time-to-maximum (Tmax), mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV), reveal that Tmax is prolonged (A), MTT is prolonged (B), CBF is slightly decreased (C), and CBV exhibits no obvious change (D) in the left frontal lobe and centrum semiovale. (E) Computed tomography angiography (CTA) indicates occlusion of A2 segment of the left anterior cerebral artery (yellow arrow). (F) DWI shows the secondary cerebral infarction in the left frontal lobe and centrum semiovale within 90 days of follow-up.
Figure 3
Figure 3
ROC curve displaying the predictive efficacy of rCBF for cerebral infarction in TIA patients ([AUC] = 0.745). AUC, area under curve; ROC, receiver operating characteristic; rCBF, relative cerebral blood flow; TIA, transient ischaemic attack.
Figure 4
Figure 4
ROC curve depicting the predictive efficacy of each model for secondary cerebral infarction within 90 days. ROC, receiver operating characteristic; rCBF, relative cerebral blood flow; WB-CTP, whole brain CT perfusion.
Figure 5
Figure 5
Calibration curve.
See this image and copyright information in PMC

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