PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome.
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.
Marchal
G
G
INSERM U320, Cyceron, Caen, France.
Serrati
C
C
Clinica Neurologica Dell’Universita di Genova, Italy
Rioux
P
P
INSERM U320, Cyceron, Caen, France.
Petit-Taboué
M C
MC
INSERM U320, Cyceron, Caen, France.|CAC F. Baclesse, Caen, France
Viader
F
F
CHRU Côte de Nacre, Caen, France
de la Sayette
V
V
CHRU Côte de Nacre, Caen, France
Le Doze
F
F
CHRU Côte de Nacre, Caen, France
Lochon
P
P
CEA DSV/DPTE, Caen, France
Derlon
J M
JM
INSERM U320, Cyceron, Caen, France.
Orgogozo
J M
JM
CHU Pellegrin,Bordeaux, France
Baron
J C
JC
INSERM U320, Cyceron, Caen, France.
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000592:standards; D014055:Tomography, Emission-Computed / Q000592:standards*