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Peer-reviewedCC BY 4.0Current Medical Imaging

CT Imaging Predictors of Early Neurologic Deterioration and 90-Day Outcomes in Thrombolysed Acute Ischemic Stroke: A Retrospective Single-Center Study

  • Yunjian Li1
  • Xianxian Zhang2
  • Tingting Wang1
  • Suyan Han1
  • Chaohui Zheng1
  • Yan Li1
  • Liping Zhang3,4
  • Senhao Zhang5
  • Xueyang Wang3,4
5 affiliations
  1. 1Department of Radiology, The Affiliated Hospital 6 of Nantong University, Yancheng Third People’s Hospital, Yancheng, China
  2. 2Department of Neurology, The Affiliated Hospital 6 of Nantong University, Yancheng Third People’s Hospital, Yancheng, China
  3. 3Department of Radiology, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
  4. 4Department of Radiology, Yancheng Traditional Chinese Medicine Hospital, Yancheng, China
  5. 5Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Abstract

Objectives: This study aimed to evaluate the association between multimodal CT imaging parameters and Early Neurologic Deterioration (END) and 90-day functional outcomes in patients with acute anterior-circulation ischemic stroke treated with intravenous thrombolysis.

Methods: In this retrospective single-center study, patients with anterior-circulation ischemic stroke who underwent multimodal CT imaging, including non-contrast CT, CT angiography, and CT perfusion prior to thrombolysis, were analyzed. Imaging parameters, including ASPECTS, regional leptomeningeal collateral (rLMC) score, infarct core, perfusion lesion, and ischemic penumbra volumes, were quantified using RAPID software. Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were applied to identify independent predictors of END and of long-term functional outcome, as measured by the 90-day modified Rankin Scale.

Results: A total of 131 patients were included, of whom 16% developed END. Lower rLMC scores and larger infarct core, perfusion lesion, and ischemic penumbra volumes were significantly associated with a higher risk of END and unfavorable 90-day outcomes. Perfusion lesion volume showed the strongest discrimination for predicting END, while the rLMC score demonstrated the highest predictive value for a favorable long-term functional outcome. ROC-derived thresholds exhibited only moderate accuracy and are considered exploratory.

Discussion: These findings highlight the prognostic relevance of collateral status and CT-derived perfusion parameters in identifying patients at higher risk of neurologic worsening and long-term disability after thrombolysis.

Conclusion: Multimodal CT imaging parameters, particularly rLMC score and perfusion-based tissue volumes, are associated with END and 90-day outcomes following thrombolysis. Further multicenter validation is necessary before clinical implementation.

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Cite

BibTeXRIS
BibTeX
@article{li2026imaging,
  title = {{CT Imaging Predictors of Early Neurologic Deterioration and 90-Day Outcomes in Thrombolysed Acute Ischemic Stroke: A Retrospective Single-Center Study}},
  author = {Yunjian Li and Xianxian Zhang and Tingting Wang and Suyan Han and Chaohui Zheng and Yan Li and Liping Zhang and Senhao Zhang and Xueyang Wang},
  journal = {Current Medical Imaging},
  year = {2026},
  month = jul,
  doi = {10.2174/0115734056417932260627205752},
  url = {https://doi.org/10.2174/0115734056417932260627205752},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - CT Imaging Predictors of Early Neurologic Deterioration and 90-Day Outcomes in Thrombolysed Acute Ischemic Stroke: A Retrospective Single-Center Study
AU  - Yunjian Li
AU  - Xianxian Zhang
AU  - Tingting Wang
AU  - Suyan Han
AU  - Chaohui Zheng
AU  - Yan Li
AU  - Liping Zhang
AU  - Senhao Zhang
AU  - Xueyang Wang
PY  - 2026
DA  - 2026/07/07
JO  - Current Medical Imaging
DO  - 10.2174/0115734056417932260627205752
UR  - https://doi.org/10.2174/0115734056417932260627205752
AB  - Objectives: This study aimed to evaluate the association between multimodal CT imaging parameters and Early Neurologic Deterioration (END) and 90-day functional outcomes in patients with acute anterior-circulation ischemic stroke treated with intravenous thrombolysis.  Methods: In this retrospective single-center study, patients with anterior-circulation ischemic stroke who underwent multimodal CT imaging, including non-contrast CT, CT angiography, and CT perfusion prior to thrombolysis, were analyzed. Imaging parameters, including ASPECTS, regional leptomeningeal collateral (rLMC) score, infarct core, perfusion lesion, and ischemic penumbra volumes, were quantified using RAPID software. Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were applied to identify independent predictors of END and of long-term functional outcome, as measured by the 90-day modified Rankin Scale.  Results: A total of 131 patients were included, of whom 16% developed END. Lower rLMC scores and larger infarct core, perfusion lesion, and ischemic penumbra volumes were significantly associated with a higher risk of END and unfavorable 90-day outcomes. Perfusion lesion volume showed the strongest discrimination for predicting END, while the rLMC score demonstrated the highest predictive value for a favorable long-term functional outcome. ROC-derived thresholds exhibited only moderate accuracy and are considered exploratory.  Discussion: These findings highlight the prognostic relevance of collateral status and CT-derived perfusion parameters in identifying patients at higher risk of neurologic worsening and long-term disability after thrombolysis.  Conclusion: Multimodal CT imaging parameters, particularly rLMC score and perfusion-based tissue volumes, are associated with END and 90-day outcomes following thrombolysis. Further multicenter validation is necessary before clinical implementation.
SN  - 1573-4056
ER  -