Perfusion CT Imaging Follows Clinical Severity in Left Hemispheric Strokes.
ABSTRACT 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.
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.
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 (R(2) = 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).
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.
SourceAvailable from: Jochen B FiebachStroke 07/2013; DOI:10.1161/STROKEAHA.113.002015 · 6.02 Impact Factor
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ABSTRACT: Purpose To determine rates of death, disability, and symptomatic intracranial hemorrhage (SICH) among patients with acute ischemic stroke selected for thrombolytic therapy by using perfusion computed tomography (CT) by conducting a systematic review and meta-analysis. Materials and Methods A search of the literature up to July 2012 was performed by using MEDLINE, EMBASE, the Cochrane Library, PubMed, and Google Scholar on terms including "brain ischemia" and "perfusion imaging." The search was unrestricted by language of publication. Two reviewers extracted study data and independently assessed the risk of study bias. Outcomes of patients selected by using perfusion CT, including case-fatality rate, favorable outcome (modified Rankin Scale [mRS] score, ≤2), and rates of SICH, were estimated. Results Thirteen experimental or observational studies that included patients who received intravenous thrombolytic treatment after perfusion CT were identified. The methodologic quality of the small studies was generally good. Overall, 90-day mortality was 10.0% (95% confidence interval [CI]: 5.4%, 15.9%). Among patients treated within 3 hours of symptom onset, mortality was 12.5% (95% CI: 6.7%, 19.7%), a favorable outcome (mRS score, ≤2) was seen in 42.5% of patients (95% CI: 16.6%, 70.9%), and the SICH rate was 3.3% (95% CI: 0.7%, 7.7%). Among patients treated more than 3 hours after symptom onset, mortality was 2.9% (95% CI: 0.0%, 12.7%), 69.9% of patients (95% CI: 0%, 83.5%) had a favorable outcome, and the SICH rate was 3.9% (95% CI: 0.8%, 9.2%). Conclusion The outcomes (mortality, morbidity, and SICH rates) for patients selected with perfusion CT to receive intravenous thrombolytic treatment more than 3 hours after symptom onset appear favorable. © RSNA, 2014 Online supplemental material is available for this article.Radiology 09/2014; DOI:10.1148/radiol.14140728 · 6.21 Impact Factor
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ABSTRACT: The ASTRAL score was recently shown to reliably predict three-month functional outcome in patients with acute ischemic stroke.International Journal of Stroke 06/2014; 9(7). DOI:10.1111/ijs.12304 · 4.03 Impact Factor