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Vol. 60, No. 5, 2008
Issue release date: October 2008
Section title: Original Paper
Eur Neurol 2008;60:244–252
(DOI:10.1159/000151700)

Perfusion CT Imaging Follows Clinical Severity in Left Hemispheric Strokes

Furtado A.D. · Smith W.S. · Koroshetz W. · Dillon W.P. · Furie K.L. · Lev M.H. · Vittinghoff E. · Schaeffer S. · Biagini T. · Hazarika O. · Wintermark M.
aNeuroradiology Section, Department of Radiology, bDepartment of Neurology and cDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif., and dStroke Service and eNeuroradiology Section, Department of Radiology, Massachusetts General Hospital, Boston, Mass., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 2/1/2008
Accepted: 3/12/2008
Published online: 8/29/2008

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 3

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE

Abstract

Objective: The purpose of this study was to assess how imaging findings on admission perfusion CT (PCT) and follow-up noncontrast CT (NCT), and their changes over time, correlate with clinical scores of stroke severity measured on admission, at discharge and at 6-month follow-up. Methods: Fifty-two patients with suspected hemispheric acute ischemic stroke underwent a PCT within the first 24 h of symptom onset and a follow-up NCT of the brain between 24 h and 3 months after the initial stroke CT study. NIH Stroke Scale (NIHSS) scores were recorded for each patient at admission, discharge and 6 months; modified Rankin scores were determined at discharge and 6 months. Baseline PCT and follow-up NCT were analyzed quantitatively (volume of ischemic/infarcted tissue) and semiquantitatively (anatomical grading score derived from the Alberta Stroke Program Early CT Score). The correlation between imaging volumes/scores and clinical scores was assessed. Analysis was performed for all patients considered together and separately for those with right and left hemispheric strokes. Results: Significant correlations were found between clinical scores and both quantitative and semiquantitative imaging. The volume of the acute PCT mean transit time lesion showed best correlation with admission NIHSS scores (R2 = 0.61, p < 0.001). This association was significantly better for left hemispheric strokes (R2 = 0.80, p < 0.001) than for right hemispheric strokes (R2 = 0.39, p = 0.131). Correlation between imaging and NIHSS scores was better than correlation between imaging and modified Rankin scores (p = 0.047). The correlation with discharge clinical scores was better than that with 6-month clinical scores (p = 0.012). Conclusions: Baseline PCT and follow-up NCT volumes predict stroke severity at baseline, discharge and, to a lesser extent, 6 months. The correlation is stronger for left-sided infarctions. This finding supports the use of PCT as a surrogate stroke outcome measure.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 2/1/2008
Accepted: 3/12/2008
Published online: 8/29/2008

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 3

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Brott T, Adams HP Jr, Olinger CP, et al: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870.
  2. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.
  3. Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200–215.
  4. Bamford JM, Sandercock PA, Warlow CP, Slattery J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989;20:828.
  5. Menezes NM, Ay H, Wang Zhu M, et al: The real estate factor: quantifying the impact of infarct location on stroke severity. Stroke 2007;38:194–197.
  6. Hillis AE, Wityk RJ, Barker PB, et al: Change in perfusion in acute nondominant hemisphere stroke may be better estimated by tests of hemispatial neglect than by the National Institutes of Health Stroke Scale. Stroke 2003;34:2392–2396.
  7. Ringman JM, Saver JL, Woolson RF, et al: Frequency, risk factors, anatomy, and course of unilateral neglect in an acute stroke cohort. Neurology 2004;63:468–474.
  8. Fink JN, Selim MH, Kumar S, et al: Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke? Stroke 2002;33:954–958.
  9. Ward NS: Neural plasticity and recovery of function. Prog Brain Res 2005;150:527–535.
  10. Butefisch CM: Plasticity in the human cerebral cortex: lessons from the normal brain and from stroke. Neuroscientist 2004;10:163–173.
  11. Hacke W, Kaste M, Fieschi C, et al, Second European-Australasian Acute Stroke Study Investigators: Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998;352:1245–1251.
  12. Wardlaw JM, Zoppo G, Yamaguchi T, Berge E: Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003:CD000213.
  13. NINDS t-PA Stroke Study Group: Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 1997;28:2109–2118.
  14. Steiner T, Bluhmki E, Kaste M, et al: The ECASS 3-hour cohort. Secondary analysis of ECASS data by time stratification. ECASS Study Group. European Cooperative Acute Stroke Study. Cerebrovasc Dis 1998;8:198–203.
  15. Albers GW, Clark WM, Madden KP, Hamilton SA: ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. Stroke 2002;33:493–495.
  16. Hacke W, Albers G, Al-Rawi Y, et al: The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 2005;36:66–73.
  17. Furlan AJ, Eyding D, Albers GW, et al: Dose Escalation of Desmoteplase for Acute Ischemic Stroke (DEDAS): evidence of safety and efficacy 3 to 9 h after stroke onset. Stroke 2006;37:1227–1231.
  18. Croquelois A, Wintermark M, Reichhart M, et al: Aphasia in hyperacute stroke: language follows brain penumbra dynamics. Ann Neurol 2003;54:321–329.
  19. Baird AE, Lovblad KO, Dashe JF, et al: Clinical correlations of diffusion and perfusion lesion volumes in acute ischemic stroke. Cerebrovasc Dis 2000;10:441–448.
  20. Warach S, Latour LL: Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brain barrier disruption. Stroke 2004;35:2659–2661.
  21. Schellinger PD, Latour LL, Wu CS, et al: The association between neurological deficit in acute ischemic stroke and mean transit time: comparison of four different perfusion MRI algorithms. Neuroradiology 2006;48:69–77.
  22. Simak J, Gelderman MP, Yu H, et al: Circulating endothelial microparticles in acute ischemic stroke: a link to severity, lesion volume and outcome. J Thromb Haemost 2006;4:1296–1302.
  23. Schellinger PD, Jansen O, Fiebach JB, et al: Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke 2000;31:1318–1328.
  24. Schellinger PD, Chalela JA, Kang DW, et al: Diagnostic and prognostic value of early MR imaging vessel signs in hyperacute stroke patients imaged <3 h and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 2005;26:618–624.
  25. Nighoghossian N, Hermier M, Adeleine P, et al: Baseline magnetic resonance imaging parameters and stroke outcome in patients treated by intravenous tissue plasminogen activator. Stroke 2003;34:458–463.
  26. Kaste M: Reborn workhorse, CT, pulls the wagon toward thrombolysis beyond 3 hours. Stroke 2004;35:357–359.
  27. Mitsias PD, Ewing JR, Lu M, et al: Multiparametric iterative self-organizing MR imaging data analysis technique for assessment of tissue viability in acute cerebral ischemia. AJNR Am J Neuroradiol 2004;25:1499–1508.
  28. Nuutinen J, Liu Y, Laakso MP, et al: Assessing the outcome of stroke: a comparison between MRI and clinical stroke scales. Acta Neurol Scand 2006;113:100–107.
  29. Sanak D, Nosal V, Horak D, et al: Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 2006;48:632–639.
  30. Ritter MA, Poeplau T, Schaefer A, et al: CT angiography in acute stroke – does it provide additional information on occurrence of infarction and functional outcome after 3 months? Cerebrovasc Dis 2006;22:362–367.
  31. Patel SC, Levine SR, Tilley BC, et al: Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. JAMA 2001;286:2830–2838.
  32. Linfante I, Llinas RH, Schlaug G, et al: Diffusion-weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior-circulation stroke. Arch Neurol 2001;58:621–628.
  33. Ernst R, Pancioli A, Tomsick T, et al: Combined intravenous and intra-arterial recombinant tissue plasminogen activator in acute ischemic stroke. Stroke 2000;31:2552–2557.
  34. Tong DC, Yenari MA, Albers GW, et al: Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 h) ischemic stroke. Neurology 1998;50:864–870.
  35. Tei H, Uchiyama S, Usui T: Clinical-diffusion mismatch defined by NIHSS and ASPECTS in non-lacunar anterior circulation infarction. J Neurol 2007;254:340–346.
  36. Wintermark M, Maeder P, Thiran JP, et al: Quantitative assessment of regional cerebral blood flows by perfusion CT studies at low injection rates: a critical review of the underlying theoretical models. Eur Radiol 2001; 11:1220–1230.
  37. Axel L: Tissue mean transit time from dynamic computed tomography by a simple deconvolution technique. Invest Radiol 1983;18:94–99.
  38. Zilkha E, Ladurner G, Iliff LD, et al: Computer subtraction in regional cerebral blood volume measurements using the EMI Scanner. Br J Radiol 1976;49:330–334.
  39. Wintermark M, Flanders AE, Velthuis B, et al: Perfusion CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 2006;37:979–985.
  40. Pexman JH, Barber PA, Hill MD, et al: Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001;22:1534–1542.
  41. Wintermark M, Reichhart M, Thiran JP, et al: Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 2002;51:417–432.
  42. Murphy BD, Fox AJ, Lee DH, et al: Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements. Stroke 2006;37:1771–1777.
  43. Schaefer PW, Roccatagliata L, Ledezma C, et al: First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiol 2006;27:20–25.
  44. Wintermark M, Fischbein NJ, Smith WS, et al: Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke. AJNR Am J Neuroradiol 2005;26:104–112.
  45. Lovblad KO, Baird AE, Schlaug G, et al: Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol 1997;42:164–170.