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REVIEW ARTICLE

Clinical value of computed tomography angiography and perfusion imaging for assessing functional prognosis and cognitive impairment after ischemic stroke

Chu Zhou1 ,  Yu-Kun Wang1 ,  Rong-Rong Liu1 ,  Qi-Yang Yuan2 ,  Wei Li1 ,  Ruo-Yu Qin1 ,  Fen-Fang Gao1 ,  Jun-Hao Yuan1 ,  Yu-Jia Zhai3 ,  Lei Ping4 ,  Yong Sun5 ,  Yu Shi6 ,  Shi-Guang Zhu1,7* ,  De-Qin Geng1,7*
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1 Department of Neurology, The First Clinical Medical School, Xuzhou Medical University, Xuzhou, Jiangsu, China
2 Department of Neurology, Shanghai University of Medicine and Health Sciences Affiliated Chongming Hospital, Shanghai, China
3 Department of Neurology, General Hospital of Xuzhou Mining Group, Xuzhou, Jiangsu, China
4 Department of Neurology, Xuzhou First People’s Hospital, Xuzhou, Jiangsu, China
5 Department of Neurology, Lianyungang First People’s Hospital, Lianyungang, Jiangsu, China
6 Department of Neurology, Xuzhou Third People’s Hospital, Xuzhou, Jiangsu, China
7 Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
Advanced Neurology, 025370091 https://doi.org/10.36922/AN025370091
Received: 9 September 2025 | Revised: 3 November 2025 | Accepted: 24 November 2025 | Published online: 10 December 2025
(This article belongs to the Special Issue Advanced Neurology 3rd Anniversary Special Issue)
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Ischemic stroke is a leading cause of disability and cognitive impairment in China. Accurate prediction of functional outcomes is crucial for formulating treatment strategies and improving patient prognosis. Computed tomography angiography (CTA) and computed tomography perfusion (CTP), established techniques for assessing cerebral hemodynamics, hold significant potential but require a more systematic synthesis of evidence in predicting neurological recovery and cognitive dysfunction. This review aims to comprehensively evaluate the existing evidence and clinical utility of CTA and CTP in assessing functional prognosis and cognitive impairment in patients with ischemic stroke. We conducted a narrative synthesis based on a systematic search of relevant literature up to August 2025 in databases including PubMed and the China National Knowledge Infrastructure. The focus is on research advances in areas where CTA and CTP are applied, such as defining the infarct core and ischemic penumbra, assessing collateral circulation, diagnosing vascular cognitive impairment (VCI), and integrating these techniques with 3D printing technology. We found that CTP quantifies infarct core and salvageable penumbra through parametric maps/software (e.g., RAPID), guiding reperfusion therapy in extended windows; CTA/CTP collateral assessment (e.g., HIR) predicts functional outcomes; and CTA/CTP identifies large-vessel pathologies and hypoperfusion as early VCI biomarkers, with CTA 3D printing expanding personalized surgical planning. However, the field currently lacks standardized assessment protocols suitable for routine clinical application, and the reliability and generalizability of predictive models in real-world practice remain to be firmly established. The potential of artificial intelligence in assisting CTA and CTP image analysis and model construction has yet to be fully exploited.

Keywords
Ischemic stroke
Computed tomography angiography
Computed tomography perfusion
Ischemic penumbra
Collateral circulation
Funding
This work was supported by the National Health Commission Brain Prevention Committee “Research and Promotion Project of Appropriate Technology Intervention for High-risk Groups of Stroke in China” (GN-2018R0009), Xuzhou Promoting Science and Technology Innovation Project (KC22241), and the “Integrated Traditional Chinese and Western Medicine for Chronic Disease Management Research Project” (CXZH2024036-24).
Conflict of interest
De-Qin Geng serves as an Editorial Board Member of this journal, but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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