Early prediction of irreversible brain damage after ischemic stroke at CT.
OBJECTIVE
To assess the capability of computed tomography (CT) in the prediction of irreversible ischemic brain damage and its association with the clinical course within 6 hours of stroke onset.


METHODS
Serial CT scans obtained within 6 hours of stroke onset, at 22-96 hours (median, 1 day), and at 2-36 days (median, 7 days) after symptom onset in 786 patients with ischemic stroke were prospectively studied, and follow-up CT scans were used as the reference. Clinical variables were assessed prospectively and independently of CT evaluation.


RESULTS
The specificity and positive predictive value of ischemic edema at baseline CT for brain infarcts were 85% (95% CI: 77%, 91%) and 96% (95% CI: 94%, 98%), respectively. Sensitivity and negative predictive values were 64% (95% CI: 60%, 67%) and 27% (95% CI: 23%, 32%), respectively. Patients without early CT findings were less severely affected (P<.001), developed smaller infarcts (P<.001), had fewer intracranial bleeding events (P<.001), and had a better clinical outcome at 90 days (P<.001) compared with patients with hypoattenuating brain tissue at early CT.


CONCLUSIONS
After ischemic stroke, x-ray hypoattenuation at CT is highly specific for irreversible ischemic brain damage if detection occurs within the first 6 hours. Patients without hypoattenuating brain tissue have a more favorable clinical course.
Department of Neuroradiology, University of Technology, Fetscherstrasse 74, D-01307 Dresden, Germany. kummer-r@rcs.urz.tu-dresden.de
R
R
von Kummer
H
H
Bourquain
S
S
Bastianello
L
L
Bozzao
C
C
Manelfe
D
D
Meier
W
W
Hacke
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D010959:Tissue Plasminogen Activator