Predicting the fate of acute ischemic lesions using perfusion computed tomography.
OBJECTIVE
To investigate whether the prognosis of ischemic tissues in acute cerebral ischemia can be predicted using perfusion computed tomography-derived parameters and, if so, which are the most useful.


METHODS
Perfusion computed tomography was performed on 13 ischemic stroke patients within 6 hours of ischemic onset. The absolute and normalized values of regional cerebral blood flow (rCBF), regional cerebral blood volume, and regional mean transit time (rMTT) and their mirror regions were divided into those that infarcted or survived. Receiver operating characteristic analysis was subsequently conducted for these 3 parameters, and their relationship to the threshold and predictability of infarction were evaluated.


RESULTS
Acute ischemic lesions with less than 63% of normal rCBF or more than 220% of rMTT almost invariably led to infarction; moreover, the receiver operating characteristic analysis revealed that both rMTT and rCBF, and their normalized derivatives, were equally predictive of infarction.


CONCLUSIONS
Both rCBF and rMTT can be used to predict the ultimate pathological prognosis of cerebral ischemia. Perfusion computed tomography is a very useful early-stage tool for the assessment of these patients.
Hagiwara
Hiroshi
H
Division of Neurology, Nephrology and Rheumatology, Internal Medicine, Nippon Medical School, Tokyo, Japan. hhagi@nms.ac.jp
Nakamura
Hidenori
H
Igarashi
Hironaka
H
Katayama
Yasuo
Y
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000175:diagnosis*; D002544:Cerebral Infarction / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol