title: Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy.
abstract: This study evaluated perfusion computed tomography (PCT) for the prediction of vessel recanalization and clinical outcome in patients undergoing intravenous thrombolysis. Thirty-nine patients with acute ischemic stroke of the middle cerebral artery territory underwent intravenous thrombolysis within 3 h of symptom onset. They all had non-enhanced CT (NECT), PCT, and CT angiography (CTA) before treatment. The Alberta Stroke Program Early Computed Tomography (ASPECT) score was applied to NECT and PCT maps to assess the extent of ischemia. CTA was assessed for the site of vessel occlusion. The National Institute of Health Stroke Scale (NIHSS) score was used for initial clinical assessment. Three-month clinical outcome was assessed using the modified Rankin scale. Vessel recanalization was determined by follow-up ultrasound. Of the PCT maps, a cerebral blood volume (CBV) ASPECT score of >6 versus < or =6 was the best predictor for clinical outcome (odds ratio, 31.43; 95% confidence interval, 3.41-289.58; P < 0.002), and was superior to NIHSS, NECT and CTA. No significant differences in ASPECT scores were found for the prediction of vessel recanalization. ASPECT score applied to PCT maps in acute stroke patients predicts the clinical outcome of intravenous thrombolysis and is superior to both early NECT and clinical parameters.
authors.affiliation: Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Str 33, 48149, Münster, Germany. kloska@uni-muenster.de
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
authors.forename: Ralf
authors.initials: R
authors.lastname: Dittrich
authors.forename: Tobias
authors.initials: T
authors.lastname: Fischer
authors.forename: Darius G
authors.initials: DG
authors.lastname: Nabavi
authors.forename: Roman
authors.initials: R
authors.lastname: Fischbach
authors.forename: Peter
authors.initials: P
authors.lastname: Seidensticker
authors.forename: Nani
authors.initials: N
authors.lastname: Osada
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D020768:Middle Cerebral Artery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents