title: Utility of early post-treatment single-photon emission computed tomography imaging to predict outcome in stroke patients treated with intravenous tissue plasminogen activator.
abstract: It is important to predict the outcome of tissue plasminogen activator (tPA)-treated patients early after the treatment for considering the post-tPA treatment option. We assessed cerebral blood flow (CBF) of tPA-treated patients with single-photon emission computed tomography (SPECT) 1 hour after tPA infusion to predict the patient outcome. Technetium-99m-hexamethylpropyleneamine oxime SPECT was performed in 35 consecutive tPA-treated patients. Asymmetry index, a contralateral-to-ipsilateral ratio of CBF, was calculated to analyze CBF quantitatively. Hypoperfusion or hyperperfusion was defined as a decrease of 25% or more or a increase of 25% or more in asymmetry index, respectively. Of all 35 patients, 23 had only hypoperfusion, 8 had both hypoperfusion and hyperperfusion, 2 had only hyperperfusion, and 2 had no perfusion abnormality. When evaluating the association between hypoperfusion and outcome, hypoperfusion volumes were significantly correlated with the modified Rankin Scale at 3 months (r = .634, P < .001). Hyperperfusion was observed in 10 patients (28.6%) and they showed a marked National Institutes of Health Stroke Scale score improvement in the first 24-hour period, which were significantly greater than those of 25 patients without hyperperfusion (P = .033). Eight patients (22.9%) with intracerebral hemorrhage (ICH) were all asymptomatic. Most ICHs were located in hypoperfusion areas, and no ICH was related to hyperperfusion. The results of the present study demonstrated that hypoperfusion volume was associated with poor outcome, whereas the presence of hyperperfusion seemed to be predictive of symptom improvement but not of development of ICH. Taken together, early post-treatment SPECT imaging seems to be a useful biomarker of outcome in tPA-treated patients.
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan; Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: abumiya@hnsmhp.or.jp.
authors.forename: Takeo
authors.initials: T
authors.lastname: Abumiya
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Katoh
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Moriwaki
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Yoshino
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Aida
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Scichinohe
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumata
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D019690:Technetium Tc 99m Exametazime; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; SPECT; hyperperfusion; hypoperfusion; tPA