ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicAnatomical Variability, Sex-Based Differences, and Age-Specific Therapies in StrokeView all articles
Prediction of stroke recurrence for patients with middle cerebral artery atherosclerotic disease by CT perfusion
Provisionally accepted
Xi Zhang1Zhi Li2He Zhang1
Zhi-Bin Chen1Guangxin Duan1Shi Huang3Hongchao Shi3Yunfeng Zhang2Junhao Du4
Guodong Xiao4
YUN LUO1*- 1Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
- 2Affiliated Hospital of Nantong University, Nantong, China
- 3Nanjing First Hospital, Nanjing, China
- 4Second Affiliated Hospital of Soochow University, Suzhou, China
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Background: This paper aimed to test the feasibility of computed tomography perfusion (CTP) in predicting stroke recurrence in patients with symptomatic middle cerebral artery atherosclerotic disease. Methods: This is a retrospective study. 322 patients from 4 advanced stroke centers diagnosed as symptomatic middle cerebral artery atherosclerotic disease, including severe stenosis and occlusion were recruited. All patients underwent head CTP, digital subtraction angiography (DSA), MR 14-21days after onset. Stroke recurrence of patients within 3 months was recorded. Patients were divided into recurrence group and control group according to whether stroke recurrence 3 months after onset. The association of imaging characteristics, other risk factors and patients stroke recurrence was assessed. Results: 104 patients presented stroke recurrence within 3 months after onset. Patients in recurrence group showed more severe vascular stenosis (p<0.001) and presented with larger hypoperfusion area than control group, as shown by larger Tmax>4s, Tmax>6s, Tmax>8s, Tmax>10s volume (P<0.001). The multiple logistic regression showed that the volume of Tmax>4s (OR=1.061 per 10 ml increase, 95% CI: 1.005-1.122, P=0.033) and Tmax>6s (OR=1.265 per 10 ml increase, 95% CI: 1.093-1.483, P=0.002) at 14-21 days after stroke were strongly associated with stroke recurrence, Tmax>4s (AUC=0.76, 95% CI: 0.70 to 0.81, P<0.001) and Tmax>6s (AUC=0.74, 95% CI: 0.68 to 0.81, P<0.001) volume had a high discriminative ability for a poor outcome. Tmax>4s volume larger than 133.60 ml being an optimal cutoff (sensitivity=80.7% and specificity=58.6%, Youden index=39.3%) and Tmax>6s volume larger than 17.95 ml being an optimal cutoff (sensitivity=83.5% and specificity=58.7%, Youden index=42.2%). Conclusion: Symptomatic middle cerebral artery atherosclerotic stenosis or occlusion patients with severe hypoperfusion might suffer a higher risk of stroke recurrence. Volume of Tmax>4s and Tmax>6s in CTP could be used to predict the prognosis of these patients.
Keywords: CTP, ICAD, Middle Cerebral Artery, Recurrence, Stroke
Received: 04 Nov 2025; Accepted: 16 Dec 2025.
Copyright: © 2025 Zhang, Li, Zhang, Chen, Duan, Huang, Shi, Zhang, Du, Xiao and LUO. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: YUN LUO
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