Ischemic stroke in evolution: Predictive value of perfusion computed tomography

Amir Kheradmand, Marc Fisher, David Paydarfar

Research output: Contribution to journalArticlepeer-review

Abstract

Various perfusion computed tomography (PCT) parameters have been used to identify tissue at risk of infarction in the setting of acute stroke. The purpose of this study was to examine predictive value of the PCT parameters commonly used in clinical practice to define ischemic penumbra. The patient selection criterion aimed to exclude the effect of thrombolysis from the imaging data. Methods: Consecutive acute stroke patients were screened and a total of 18 patients who initially underwent PCT and CT angiogram (CTA) on presentation but did not qualify to receive thrombolytic therapy were selected. The PCT images were postprocessed using a delay-sensitive deconvolution algorithm. All the patients had follow-up noncontrast CT or magnetic resonance imaging to delineate the extent of their infarction. The extent of lesions on PCT maps calculated from mean transit time (MTT), time to peak (TTP), cerebral blood flow, and cerebral blood volume were compared and correlated with the final infarct size. A collateral grading score was used to measure collateral blood supply on the CTA studies. Results: The average size of MTT lesions was larger than infarct lesions (P <.05). The correlation coefficient of TTP/infarct lesions (r =.95) was better than MTT/infarct lesions (r =.66) (P =.004). Conclusions: A widely accepted threshold to define MTT lesions overestimates the ischemic penumbra. In this setting, TTP with appropriate threshold is a better predictor of infarct in acute stroke patients. The MTT/TTP mismatch correlates with the status of collateral blood supply to the tissue at risk of infarction.

Original languageEnglish (US)
Pages (from-to)836-843
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number5
DOIs
StatePublished - 2014

Keywords

  • Computed tomography
  • mean transit time
  • perfusion
  • stroke
  • time to peak

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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