Widened arterial time-density curves of CTP may identify cardioembolic etiology in acute large-artery occlusion stroke.

BACKGROUND

Identifying cardioembolism (CE) in large artery occlusion acute ischemic stroke (LAO-AIS) is critical for treatment decisions but often requires time-consuming diagnostic workups. Arterial and venous time-density curves (ATDC and VTDC), automatically derived from brain CTP, may reflect cardiac dysfunction and thrombus formation, offering a rapid alternative for CE detection.

PURPOSE: To evaluate the diagnostic utility of CTP-derived ATDC and VTDC parameters, combined with thrombus attenuation, for identifying CE in LAO-AIS patients.

MATERIALS AND

METHODS

This retrospective study analyzed 103 LAO-AIS patients (median age 69 [IQR 63-77] years; 63 men) with anterior circulation occlusions who underwent CTP within 24 h of onset. Patients were classified into CE (n = 56) and non-CE (n = 47) groups per TOAST criteria. ATDC and VTDC parameters (onset, peak, end, width) and thrombus CT attenuation were measured. Diagnostic performance was assessed using univariable and multivariable logistic regression.

RESULTS

Compared to the non-CE group, the CE group exhibited significant delays in onset, peak, and end times, along with wider curve widths of ATDC and VTDC, and higher thrombus attenuation (PFDR≤0.001). ATDC width demonstrated the highest discriminative power for CE (AUC: 0.83 [95%CI: 0.74-0.89]; sensitivity: 73.2%, specificity: 87.2%; cutoff-value: 27s). Multivariable analysis confirmed ATDC width (OR = 1.214; 95% CI: 1.080-1.365; P = 0.001) and thrombus attenuation (OR = 1.114; 95% CI: 1.006-1.233; P = 0.038) as independent CE predictors, with a combined AUC of 0.93.

CONCLUSIONS

Prolonged ATDC and VTDC phases, wider curve widths, and elevated thrombus attenuation on CTP are strongly associated with CE in LAO-AIS, providing a rapid, imaging-based diagnostic tool.