Relative Filling Time Delay Based on CT Perfusion Source Imaging: A Simple Method to Predict Outcome in Acute Ischemic Stroke

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Fig 1.
A 67-year-old woman with left hemiparesis and dysarthria who presented to the hospital 2 hours after onset. CTA identified a right intracranial ICA occlusion. CTP-SI showed that the contrast (black circles) was first detected at 20 seconds in the left Sylvian fissure (A) and at 27 seconds in the affected right hemisphere (B). The relative filling time delay was, therefore, 7 seconds.
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Fig 2.
Correlation between rFTD and baseline NIHSS scores, 24-hour ASPECTS, and 90-day mRS scores.
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Fig 3.
Longer median rFTD was significantly associated with poor functional and radiologic outcomes.

Table 1:

Comparison of patient characteristics in those with good-versus-poor outcomes

	mRS (0–2) (n = 23)	mRS (3–6) (n = 32)	P Value	Alive (n = 43)	Dead (n = 12)	P Value	ASPECTS (>7) (n = 21)	ASPECTS (≤7) (n = 39)	P Value
Age (median) (yr)	69 (41–85)	73.5 (54–88)	.014	69 (41–85)	79 (66–88)	.005	72 (52–83)	73 (41–88)	.877
Female (%)	26	56.2	.026	37.2	66.6	.101	33.3	51.2	.277
Hypertension (%)	52.1	62.5	.444	60.4	50	.516	56.4	61.9	.786
Diabetes mellitus (%)	26	28.1	.867	23.2	41.6	.205	33.3	25.6	.560
Hyperlipidemia (%)	60.8	46.8	.305	48.8	66.6	.274	61.9	51.2	.587
Current or past smoker (%)	26	9.3	.143	20.9	0	.181	14.2	20.5	.731
Atrial fibrillation (%)	34.3	34.7	.975	32.5	41.7	.733	42.8	35.8	.781
Baseline NIHSS (median)	13 (6–20)	19 (6–27)	.001	15 (6–27)	21 (15–26)	.001	12 (3–24)	18 (6–27)	.003
OTT (median) (min)	120 (61–255)	140 (75–265)	.366	140 (61–265)	124 (77–200)	.683	137 (61–250)	140 (76–265)	.364
IV-tPA (%)	60.9	71.9	.561	67.4	66.7	1.000	69.2	66.7	1.000
IA-tPA/UK (%)	13	6.2	.639	7.3	16.7	.298	11.7	8.3	1.000
Clot retrieval (%)	26.1	21.9	.717	25.5	16.7	.709	23.1	23.8	1.000
rFTD (median) (sec)	3.5 (0–7.5)	5.75 (0–10)	.001	4 (0–17)	6.5 (3–20)	.002	3.5 (0–6.5)	5.5 (2–20)	.002

Note:—IA indicates intra-arterial; rFTD, relative filling delay time; UK, urokinase; OTT, onset to treatment time.

Table 2:

Multivariate logistic regression for clinical and radiologic outcome

Poor Outcomes	Predictors	β	SE	P Value
90-Day mRS 3–6	Age	0.097	0.043	.024
	Sex	0.548	0.816	.501
	Baseline NIHSS	0.207	0.091	.023
	rFTD	0.354	0.178	.047
90-Day death	Age	0.185	0.074	.01
	Baseline NIHSS	0.239	0.116	.028
	rFTD	0.302	0.158	.039
24-Hour ASPECTS ≤7	Baseline NIHSS	0.114	0.065	.082
	rFTD	0.456	0.162	.005