Ghost infarct core

Last revised by Rohit Sharma on 2 Mar 2024

Ghost infarct core refers to the phenomenon that CT perfusion may overestimate infarct core on admission, especially in the early time window of a stroke, by predicting lesion in areas that will not show infarct on follow-up imaging 1. This mismatch is defined as the initial infarct core minus final infarct (>10 mL) 3. Ghost infarct core may occur in up to 10% of patients selected for endovascular clot retrieval, particularly in younger patients 3.

This is a clinically important concept because selecting patients for reperfusion therapies based on the CT perfusion estimated penumbra may deny treatment to patients who might still benefit from reperfusion. Since overestimation of the infarct core by CT perfusion seems to be time-dependent, penumbra especially among early arrivers should be interpreted cautiously 2.

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