Hemodynamic assessment of acute stroke using dynamic single-slice computed tomographic perfusion imaging.
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.


METHODS
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).


METHODS
A stroke unit in a university hospital.


METHODS
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
University Hospital Hamburg Eppendorf, Department of Neurology, Martinistr. 52, 20246 Hamburg, Germany. roether@uke.uni-hamburg.de
J
J
Röther
L
L
Jonetz-Mentzel
A
A
Fiala
J R
JR
Reichenbach
M
M
Herzau
W A
WA
Kaiser
C
C
Weiller
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed