title: Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps.
abstract: OBJECTIVE
  The purpose of this study was to compare the incidence of large hypoperfusion (greater than two-thirds of MCA territory) on computed tomography (CT) perfusion maps between hyperacute middle cerebral artery (MCA) stroke patients without or with malignant cerebral edema.
  
  
  METHODS
  Twenty-seven patients diagnosed with a hyperacute MCA stroke who had an initial National Institutes of Health Stroke Scale (NIHSS) score greater than 10 were included. Multiphasic perfusion CT was performed within 6 hours of symptom onset. Patients were divided into 2 groups: the malignant group (n = 11), composed of patients who died within 7 days, and the nonmalignant group, which included all other patients (n = 16). Unenhanced CT and CT perfusion maps were assessed and compared between the 2 groups with special emphasis on examining the CT findings, including hyperdense MCA sign, large (greater than two-thirds) hypoattenuation and hypoperfusion in the MCA territory, and hypoattenuation in the basal ganglia and other vascular territories.
  
  
  RESULTS
  The incidence of large hypoattenuation (greater than two-thirds of MCA territory) on unenhanced CT and large hypoperfusion on CT perfusion maps differed significantly between the 2 groups (P < 0.05). Large hypoperfusion on the CT total perfusion map was most accurate (93%) among various CT findings for the prediction of malignant MCA infarction with high sensitivity (91%), specificity (94%), and positive predictive value (91%).
  
  
  CONCLUSIONS
  The incidence of large hypoperfusion on a CT perfusion map was higher in the malignant group than the nonmalignant group. CT perfusion maps may provide added information about cerebral perfusion and could be a useful predictor of malignant MCA infarction.
authors.affiliation: Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Ryoo
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Na
authors.forename: Sam Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Dae Seob
authors.initials: DS
authors.lastname: Choi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods