Hemodynamic Assessment of Acute Stroke Using Dynamic Single-Slice Computed Tomographic Perfusion Imaging

Arch Neurol. 2000 Aug;57(8):1161-6. doi: 10.1001/archneur.57.8.1161.

Abstract

Background: Stroke management would benefit from a broadly available imaging tool that detects perfusion deficits in patients with acute stroke.

Objective: To determine the role of dynamic, single-slice computed tomographic (CT) perfusion imaging (CTP) in the assessment of acute middle cerebral artery stroke.

Design and patients: Imaging with CTP and CT within the first 6 hours of symptom onset and before the start of treatment in a consecutive clinical series of 22 patients (mean age, 68.3 years; 14 women; studied within 143 +/- 96 minutes of stroke onset).

Setting: A stroke unit in a university hospital.

Main outcome measures: Area of the perfusion deficit (nAP(0)) from time-to-peak maps, hemispheric lesion area from follow-up CT (HLA(F)), final infarct volume, and stroke recovery (National Institutes of Health Stroke Scale scores).

Results: Eighteen patients had perfusion deficits in the middle cerebral artery territory and corresponding hypoattenuation in follow-up CT. Three patients with normal CTP findings showed lacunar infarctions or normal findings on follow-up CT. In 1 patient, CTP did not reveal a territorial deficit above the imaging slice. The overall sensitivity and specificity of CTP for the detection of perfusion deficits in patients with proven territorial infarction (n = 18) on follow-up CT were 95% and 100%, respectively. The nAP(0) was significantly correlated with the National Institutes of Health Stroke Scale score at admission (P<.003) and the HLA(F) (P<.001). Different stroke patterns were identified in patients with follow-up CTP (n = 10): (1) initial perfusion deficit and partial nutritional reperfusion (nAP(0)>HLA(F); n = 6), (2) initial perfusion deficit and nonnutritional reperfusion (nAP( 0)>/=HLA(F); n = 2), and (3) initial perfusion deficit without reperfusion (nAP(0)>/=HLA(F); n = 2).

Conclusions: Computed tomographic perfusion imaging detects major perfusion deficits in the middle cerebral artery territory. Because CTP is broadly available, it may play a role in acute stroke management. Arch Neurol. 2000;57:1161-1166

Publication types

  • Clinical Trial

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnostic imaging
  • Cerebrovascular Circulation*
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging*
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Stroke / diagnostic imaging*
  • Tomography, X-Ray Computed*