title: Multimodal Computed Tomography Based Definition of Cerebral Imaging Profiles for Acute Stroke Reperfusion Therapy (CT-DEFINE): Results of a Prospective Observational Study.
abstract: OBJECTIVE
  To prospectively evaluate the prognostic impact of multimodal computed tomography-based imaging in ischemic stroke patients potentially eligible for reperfusion therapy.
  
  
  METHODS
  Anterior circulation stroke patients underwent non-contrast CT (NCCT), CT-angiography, and CT-perfusion within 12 h from symptom-onset. Patients could be treated with intravenous-tissue plasminogen activator (IV-tPA), endovascular or combined reperfusion therapies. Cerebral imaging profiles (IP) were NCCT-Alberta Stroke Program Early CT Score (ASPECTS) > 7 (IP1); NCCT-ASPECTS > 5 and proximal occlusion on CT-angiography (IP2); CT-perfusion mismatch between cerebral blood volume (CBV)-ASPECTS, and cerebral blood flow (CBF)-ASPECTS ≥ 2 (IP3). Favorable outcome was defined as modified Rankin Scale ≤ 2 at 3 months.
  
  
  RESULTS
  Of 102 included patients, 62 (61%) received any reperfusion therapy. In IP2 and IP3, favorable outcome was more frequent in patients with reperfusion therapy than in those without; however, this did not reach statistical significance (IP2: 39% vs 15%, p = 0.26; IP3: 50% vs 17 %; p = 0.31). No difference was seen in IP1 (58% vs 58%, p = 1.0). In IP2, patients with IV-tPA alone achieved better functional outcome (50% vs 11%, p = 0.03) and lower mortality (0% vs 28%, p = 0.045) than those without.
  
  
  CONCLUSIONS
  Our results suggest a benefit with imaging profile selection based upon the combination of a small-to-moderate-sized infarction and a visible intracranial occlusion in patients receiving IV-tPA. Reperfusion therapy may be futile in patients without proven vessel occlusion.
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Kristian.Barlinn@uniklinikum-dresden.de.
authors.forename: K
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Seibt
authors.affiliation: Division of Neuroradiology, University Hospital Dresden, Dresden, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Engellandt
authors.affiliation: Division of Neuroradiology, University Hospital Dresden, Dresden, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gerber
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Puetz
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kepplinger
authors.affiliation: Division of Neuroradiology, University Hospital Dresden, Dresden, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Wunderlich
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: L-P
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Bodechtel
authors.affiliation: Institute for Medical Informatics and Biometry, University Hospital Dresden, Dresden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Koch
authors.affiliation: Division of Neuroradiology, University Hospital Dresden, Dresden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: von Kummer
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.|Elblandklinikum Meissen, Department of Neurology, Academic Teaching Hospital of the University of Technology Dresden, Meissen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Dzialowski
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Imaging profile; Outcome; Reperfusion therapy; Stroke