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Volume 14
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10.3390/jcm14092991
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Article

Ct-Perfusion Absolute Ghost Infarct Core Is a Rare Phenomenon Associated with Poor Collateral Status in Acute Ischemic Stroke Patients

by
Giorgio Busto
1,*,
Andrea Morotti
2,
Ilaria Casetta
3,
Anna Poggesi
4,
Davide Gadda
1,
Andrea Ginestroni
1,
Giorgio Arcara
3,
Arianna Rustici
5,
Andrea Zini
6,
Alessandro Padovani
2 and
Enrico Fainardi
7
1
Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
2
Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
3
IRCCS San Camillo Hospital, 30121 Venice, Italy
4
Stroke Unit, Careggi University Hospital, 50134 Florence, Italy
5
IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI di Neuroradiologia Ospedale Maggiore, 40100 Bologna, Italy
6
IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, 40100 Bologna, Italy
7
Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(9), 2991; https://doi.org/10.3390/jcm14092991
Submission received: 18 March 2025 / Revised: 24 April 2025 / Accepted: 24 April 2025 / Published: 25 April 2025
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
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Abstract

Background: CT perfusion (CTP) overestimation of core volume >10 mL compared to the final infarct volume (FIV) size is the current definition of the ghost infarct core (GIC) phenomenon. However, subsequent infarct growth might influence FIV. We aimed to report a more reliable assessment of GIC occurrence, defined as no evidence of infarct at 24 h follow-up imaging, compared to CTP core volume at admission. This phenomenon was named absolute GIC (aGIC), and we investigated its prevalence and predictors. Methods: A total of 652 consecutive stroke patients with large vessel occlusion who achieved successful recanalization (mTICI 2b-3) after endovascular treatment (EVT) and non-contrast CT (NCCT) follow-up imaging at 24 h were retrospectively analyzed. Ischemic core volume was automatically generated from CTP, and FIV was manually determined on follow-up NCCT. Multivariable logistic regression was used to explore aGIC predictors. Results: We included 652 patients (53.3% female, median age 75 years), of whom 35 (5.3%) had an aGIC. The aGIC group showed higher ASPECTS (p < 0.001), shorter (<3 h) onset-to-imaging time (p < 0.016), poorer collaterals (p < 0.001), and higher hypoperfusion intensity ratio (p < 0.001) compared to the non-aGIC group. In multivariate analysis, ASPECTS (odds ratio (OR), 2.37; p <0.001), onset-to-imaging time (OR, 0.99; p = 0.034), collateral score (OR, 0.24; p < 0.001), and hypoperfusion intensity ratio (OR, 23.2; p < 0.001) were independently associated with aGIC. Conclusions: aGIC is a more reliable evaluation of infarct core volume overestimation assessed on admission CTP and represents a rare phenomenon, associated with ultra-early presentation and poor collaterals.
Keywords: acute ischemic stroke; absolute ghost infarct core; CT perfusion; collaterals; endovascular treatment; large vessel occlusion acute ischemic stroke; absolute ghost infarct core; CT perfusion; collaterals; endovascular treatment; large vessel occlusion

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MDPI and ACS Style

Busto, G.; Morotti, A.; Casetta, I.; Poggesi, A.; Gadda, D.; Ginestroni, A.; Arcara, G.; Rustici, A.; Zini, A.; Padovani, A.; et al. Ct-Perfusion Absolute Ghost Infarct Core Is a Rare Phenomenon Associated with Poor Collateral Status in Acute Ischemic Stroke Patients. J. Clin. Med. 2025, 14, 2991. https://doi.org/10.3390/jcm14092991

AMA Style

Busto G, Morotti A, Casetta I, Poggesi A, Gadda D, Ginestroni A, Arcara G, Rustici A, Zini A, Padovani A, et al. Ct-Perfusion Absolute Ghost Infarct Core Is a Rare Phenomenon Associated with Poor Collateral Status in Acute Ischemic Stroke Patients. Journal of Clinical Medicine. 2025; 14(9):2991. https://doi.org/10.3390/jcm14092991

Chicago/Turabian Style

Busto, Giorgio, Andrea Morotti, Ilaria Casetta, Anna Poggesi, Davide Gadda, Andrea Ginestroni, Giorgio Arcara, Arianna Rustici, Andrea Zini, Alessandro Padovani, and et al. 2025. "Ct-Perfusion Absolute Ghost Infarct Core Is a Rare Phenomenon Associated with Poor Collateral Status in Acute Ischemic Stroke Patients" Journal of Clinical Medicine 14, no. 9: 2991. https://doi.org/10.3390/jcm14092991

APA Style

Busto, G., Morotti, A., Casetta, I., Poggesi, A., Gadda, D., Ginestroni, A., Arcara, G., Rustici, A., Zini, A., Padovani, A., & Fainardi, E. (2025). Ct-Perfusion Absolute Ghost Infarct Core Is a Rare Phenomenon Associated with Poor Collateral Status in Acute Ischemic Stroke Patients. Journal of Clinical Medicine, 14(9), 2991. https://doi.org/10.3390/jcm14092991

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