title: Computed tomography perfusion prognostic maps do not predict reversible and irreversible neurological dysfunction following reperfusion therapies.
abstract: BACKGROUND
  We aimed to evaluate the ability of commercially available computed tomography perfusion (CTP) prognostic maps software to identify reversibly and irreversibly damaged brain functions in the best case scenario: patients who achieved early and complete tissue reperfusion.
  
  
  METHODS
  Consecutive ischemic stroke patients who received reperfusion therapies, those with early (less than two-hours from treatment initiation) and complete Thrombolysis in Myocardial Infarction grade III or equivalent reperfusion were included in the analysis. Computed tomography perfusion prognostic maps were assigned as 'red,' or irreversible if cerebral blood volume declined below 2 ml/100 g and 'green,' or recoverable if the affected/unaffected mean transit time ratio was >1.45. Only patients with middle cerebral artery territory affected were included and subcomponents of the National Institutes of Health Stroke Scale scale pre- and posttreatment were analyzed based on anatomical correlation of the affected CTP areas and corresponding neurological functions.
  
  
  RESULTS
  Among 109 consecutive patients who had intra-arterial reperfusion procedures, 16 (age 60 ± 17 years, 56% men, median National Institutes of Health Stroke Scale 13 . 5, interquartile range 7-18) had pretreatment CTP and had early complete reperfusion. We identified 44 affected areas on CTP (red 12 (27%), green 32 (73%)) with corresponding measurable neurological deficits including aphasia, arm, face weakness, and inattention. Red areas correctly identified 5/12 (42%) of functions that did not recover despite early reperfusion. Green areas correctly identified 18/32 (56%) of functions that recover after early reperfusion (OR 0.92, 95% CI 0.25-3.39, P = 1.0).
  
  
  CONCLUSIONS
  In-patients achieving early and complete reperfusion, pretreatment CTP prognostic maps were not predictive for irreversibly or reversibly lost neurologic functions.
authors: Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL, USA.
authors: Limin
authors: L
authors: Zhao
authors: Kristian
authors: K
authors: Barlinn
authors: Asim K
authors: AK
authors: Bag
authors: Maruthi
authors: M
authors: Kesani
authors: Luis F
authors: LF
authors: Cava
authors: Clotilde
authors: C
authors: Balucani
authors: Anne W
authors: AW
authors: Alexandrov
authors: Joseph A
authors: JA
authors: Horton
authors: Damon E
authors: DE
authors: Patterson
authors: Mark R
authors: MR
authors: Harrigan
authors: Karen C
authors: KC
authors: Albright
authors: Andrei V
authors: AV
authors: Alexandrov
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001037:Aphasia / Q000175:diagnosis / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D001931:Brain Mapping; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D055420:Perfusion Imaging; D011379:Prognosis; D015424:Reperfusion / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed