Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients.
OBJECTIVE
Besides classic criteria, cerebral perfusion imaging could improve patient selection for thrombolytic therapy. The purpose of this study was to compare quantitative perfusion CT imaging and qualitative diffusion- and perfusion-weighted MRI (DWI and PWI) in acute stroke patients at the time of their emergency evaluation.


METHODS
Thirteen acute stroke patients underwent perfusion CT and DWI or PWI on admission. The size of infarct and ischemic lesion (infarct plus penumbra) on the admission perfusion CT was compared with that of the MR abnormalities as shown on the DWI trace and on the relative cerebral blood volume, cerebral blood flow, time to peak, and mean transit time maps calculated from PWI studies.


RESULTS
The most significant correlation was found between infarct size on the admission perfusion CT and abnormality size on the admission DWI map (r=0.968, P<0.001). A significant correlation was also observed between the size of the ischemic lesion (infarct plus penumbra) on the admission perfusion CT and the abnormality size on the mean transit time map calculated from admission PWI (r=0.946, P<0.001). Information about cerebral infarct and total ischemia (infarct plus penumbra) carried by both imaging techniques was similar, with slopes of 0.913 and 0.905, respectively.


CONCLUSIONS
An imaging technique may be helpful in the identification of cerebral penumbra in acute stroke patients and thus in the selection of patients for thrombolytic therapy. Perfusion CT and DWI/PWI are equivalent in this task.
Wintermark
M
M
Department of Diagnostic and Interventional Radiology, University Hospital, Lausanne, Switzerland. Max.Wintermark@chuv.hospvd.ch
Reichhart
M
M
Cuisenaire
O
O
Maeder
P
P
Thiran
J-P
JP
Schnyder
P
P
Bogousslavsky
J
J
Meuli
R
R
D000208:Acute Disease; D000368:Aged; D001783:Blood Flow Velocity; D001810:Blood Volume; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002560:Cerebrovascular Circulation; D003955:Diagnostic Tests, Routine; D004058:Diffusion; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010477:Perfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed