Abstract

Background: Acute ischemic stroke (AIS) requires rapid and accurate assessment to guide reperfusion therapy. While non-contrast CT (NCCT) is widely available, CT perfusion (CTP) provides additional information on infarct core and penumbra. This study aimed to evaluate the association between clinical characteristics, NCCT findings, and CTP parameters in AIS patients. Methods: A retrospective cross-sectional study was conducted on 44 AIS patients who underwent NCCT and CTP at Universitas Airlangga Hospital (2024-2025). Clinical data, imaging findings, and perfusion parameters (CBF, CBV, MTT, Tmax, core, penumbra, and mismatch ratio) were analyzed. Bivariate analysis, Spearman correlation, and ROC analysis were performed, with p < 0.05 considered significant. Results: Most patients had mild stroke (NIHSS <15). Poor NIHSS scores were associated with mixed lesion location (p=0.011), insular ribbon sign (p=0.003), and loss of gray-white matter differentiation (p=0.006). CTP parameters showed significant differences, with lower CBF and CBV, prolonged MTT, and larger core and penumbra volumes in severe stroke (p<0.05). NIHSS correlated positively with MTT (r=0.317; p=0.036). ROC analysis showed strong predictive performance for CBV (AUC=0.881), penumbra (AUC=0.888), and CBF (AUC=0.838). Conclusion: Clinical severity in AIS is significantly associated with NCCT findings and CTP parameters. Perfusion imaging, particularly CBV, CBF, and penumbra volume, demonstrates exploratory discriminative ability for stroke severity. Integration of clinical and multimodal imaging may improve evaluation and decision-making in AIS management.