title: Computed tomography perfusion of ischaemic stroke patients in a rural Malaysian tertiary referral centre.
abstract: BACKGROUND
  Computed tomography (CT) perfusion is a new method to diagnose ischaemic stroke especially in developing countries. It identifies the area and is useful to predict the size of final infarction. The aim of this study was to assess cerebral ischaemia with CT perfusion (CTP) among patients with acute ischaemic stroke in Hospital Universiti Sains Malaysia, a tertiary referral centre in a rural setting.
  
  
  METHODS
  42 consecutive unenhanced CT and CTP examinations of the brain in adult patients were evaluated prospectively. Unenhanced CT images were divided into normal, suspicious or frank infarction. CTP images was classified as normal or ischaemic. Subgroup analysis was carried out with a limit of six hours from time of ictus.
  
  
  RESULTS
  Out of 42 patients, 20 had frank infarction on unenhanced CT, 15 had suspicious CT studies, while seven were normal. There was no significant association of demographical, clinical and radiological parameters to CTP in the whole group among acute stroke patients without frank infarction. Among the subgroup of patients without frank infarction, there was no significant association between unenhanced CT and CTP in patients who were studied less than six hours after stroke (p-value is 0.063) as well as those after six hours (p-value is 0.317). The prevalence of a normal unenhanced CT and positive CTP for ischaemia was 22.7 percent (95 percent confidence interval 7.8, 45.4).
  
  
  CONCLUSIONS
  CTP may be a useful imaging tool for determining cerebral infarction in a rural-based community population, especially in cases where the unenhanced CT is normal. Thrombolysis is a therapeutic option, even when the history of onset of stroke is unclear.
authors.affiliation: Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
authors.forename: K
authors.initials: K
authors.lastname: Man
authors.forename: A M M
authors.initials: AM
authors.lastname: Kareem
authors.forename: N A
authors.initials: NA
authors.lastname: Ahmad Alias
authors.forename: I L
authors.initials: IL
authors.lastname: Shuaib
authors.forename: J
authors.initials: J
authors.lastname: Tharakan
authors.forename: J M
authors.initials: JM
authors.lastname: Abdullah
authors.forename: A
authors.initials: A
authors.lastname: Prasad
authors.forename: A M
authors.initials: AM
authors.lastname: Hussin
authors.forename: N N
authors.initials: NN
authors.lastname: Naing
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed