Automated Measurement of Computed Tomography Acute Ischemic Core in Stroke: Does the Emperor Have No Clothes?

Abstract

Bouslama et al 1 have performed a very nice study comparing automated computed tomography (CT) ischemic core lesion volumes from acute noncontrast CT and perfusion CT (CTP) in a large number of patients with acute anterior circulation large vessel occlusion. The reference standard for the acute automated CT core lesion volumes was final infarct volume (FIV), predominantly measured on magnetic resonance imaging, within 72 hours of onset. To avoid that there would be infarct growth between acute CT and the FIV measurement the authors sensibly restricted analysis to patients who had complete reperfusion after endovascular thrombectomy. This should mean that if acute ischemic core measurements on CT are accurate, they should be very close to the FIV. Indeed, the authors concluded that automated NCCT and CTP ischemic core volumes were similar in estimating FIV. It would be more accurate (but less polite) to say that automated NCCT ischemic core volume and CTP core volume were similarly poor in estimating FIV.