PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome

Lancet. 1993 Apr 10;341(8850):925-7. doi: 10.1016/0140-6736(93)91214-7.


We used positron emission tomography (PET) to assess the relation between combined imaging of cerebral blood flow and oxygen consumption 5-18 h after first middle cerebral artery (MCA) stroke and neurological outcome at 2 months. All 18 patients could be classified into three visually defined PET patterns of perfusion and oxygen consumption changes. Pattern I (7 patients) suggested extensive irreversible damage and was consistently associated with poor outcome. Pattern II (5) suggested continuing ischaemia and was associated with variable outcome. Pattern III (6), with hyperperfusion and little or no metabolic alteration, was associated with excellent recovery, which suggests that early reperfusion is beneficial. This relation between PET and outcome was highly significant (p < 0.0005). The results suggest that within 5-18 h of stroke onset, PET is a good predictor of outcome in patterns I and III, for which therapy seems limited. The absence of predictive value for pattern II suggests that it is due to a reversible ischaemic state that is possibly amenable to therapy. These findings may have important implications for acute MCA stroke management and for patients' selection for therapeutic trials.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / classification
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / mortality
  • Cerebrovascular Circulation*
  • Cerebrovascular Disorders / classification
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Oxygen Consumption*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Thrombolytic Therapy / standards
  • Tomography, Emission-Computed / standards*