title: Relation between stroke severity, patient characteristics and CT-perfusion derived blood-brain barrier permeability measurements in acute ischemic stroke.
abstract: OBJECTIVE
  Increased blood-brain barrier permeability (BBBP) can result from ischemia. In this study the relation between stroke severity, patient characteristics and admission BBBP values measured with CT-perfusion (CTP) was investigated in acute ischemic stroke patients.
  
  
  METHODS
  From prospective data of the Dutch Acute Stroke Study 149 patients with a middle cerebral artery stroke and extended CTP were selected. BBBP values were measured in the penumbra and infarct core as defined by CTP thresholds, and in the contra-lateral hemisphere. The relation between stroke (severity) variables and patient characteristics, including early CT signs, dense vessel sign (DVS), time to scan and National Institute of Health Stroke Score (NIHSS), and BBBP parameters in penumbra and infarct core was quantified with regression analysis.
  
  
  RESULTS
  Early CT signs were related to higher BBBP values in the infarct core (B = 0.710), higher ipsi- to contra-lateral BBBP ratios (B = 0.326) and higher extraction ratios in the infarct core (B = 16.938). Females were found to have lower BBBP values in penumbra and infarct core (B = - 0.446 and - 0.776 respectively) and lower extraction ratios in the infarct core (B = - 10.463). If a DVS was present the ipsi- to contra-lateral BBBP ratios were lower (B = - 0.304). There was no relation between NIHSS or time to scan and BBBP values.
  
  
  CONCLUSIONS
  Early CT signs are related to higher BBBP values in the infarct core, suggesting that only severe ischemic damage alters BBBP within the first hours after symptom onset.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands. alexanderhorsch@gmail.com.|Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands. alexanderhorsch@gmail.com.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Horsch
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van Seeters
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Joris M
authors.initials: JM
authors.lastname: Niesten
authors.affiliation: Department of Neurology, Utrecht Stroke Center, University Medical Center, Utrecht, The Netherlands.
authors.forename: Merel J A
authors.initials: MJ
authors.lastname: Luitse
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Vos
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Irene C
authors.initials: IC
authors.lastname: van der Schaaf
authors.affiliation: Department of Neurology, Utrecht Stroke Center, University Medical Center, Utrecht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Department of Neurology, Utrecht Stroke Center, University Medical Center, Utrecht, The Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584, Utrecht, CX, The Netherlands.
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Acute ischemic stroke; Blood-brain barrier permeability; CT perfusion; Dense vessel sign; Early CT signs