Abstract Background and aims Extensive evidence support the role of CT Perfusion (CTP) in selecting candidates for reperfusion therapies within the extended time window (4.5–24 hours) for acute ischemic stroke (AIS). However, evidence is insufficient to support non-contrast CT (NCCT) as an alternative for patient selection. This study evaluates the correlation between automated NCCT and CTP metrics and their impact on clinical outcomes. Methods Consecutives AIS patients were evaluated at a comprehensive stroke center for treatment within the extended time window. All patients underwent NCCT and CTP. Neuroradiological parameters-including acute hypodensity, ASPECTS on NCCT, and CTP ischemic core volumes- were evaluated using Brainomix software. Clinical outcomes (NIHSS, 3-month mRS) and radiological outcomes (symptomatic intracerebral hemorrhage sICH) were recorded. Results Among 150 patients, ischemic core volume (rCBF 30%) showed a strong correlation with NCCT acute hypodensity (r = 0.69;p = 0.001) and ASPECTS (r = 0.69;p = 0.001). Acute hypodensity also correlated with NIHSS scores at admission and discharge (p 0.001). Multivariate regression analysis confirmed a significant relationship between 3-month mRS, acute hypodensity (p = 0.01), and rCBF (p = 0.01), even after adjusting for baseline NIHSS and treatment. Neither acute hypodensity (p = 0.65) nor rCBF (p = 0.70) was associated with sICH. Conclusions Our study highlights a robust correlation between automated NCCT metrics, CTP parameters, and clinical outcomes in a real-world setting. While NCCT shows prognostic value, further studies are warranted to assess its role as a primary selection tool in the extended time window. Conflict of interest Valerio Melas: nothing to disclose
Melas et al. (2026) studied this question.