title: Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke.
abstract: BACKGROUND
  It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outcomes.
  
  
  METHODS
  A retrospective study of patients with anterior circulation stroke undergoing reperfusion therapies who had a PCT before treatment and an assessment of vessel recanalization post treatment was conducted. Tissue at risk was considered as that with reduced cerebral blood flow, whereas the infarct core was the region of reduced cerebral blood volume, the mismatch region being salvageable tissue. The volume of hypodensity in slices corresponding to perfusion acquisition cage in 24-hour computed tomography (partial lesion volume [PLV]) was measured. Outcome variables were the amount of preserved tissue, that is, the difference between volumes of tissue at risk and PLV expressed as a percentage, and the modified Rankin Scale (mRS) score at 3 months.
  
  
  RESULTS
  Patients (n = 34) meeting the inclusion criteria were included. Vessel recanalization was associated with a larger amount of tissue at risk preserved from definite lesion (89% [interquartile range {IQR}: 76-94] versus 46% [IQR: 23-86], P < .005). The amount of preserved tissue correlated with clinical outcome at 24 hours: for each 10% of preserved tissue, the National Institutes of Health Stroke Scale score improved by 3 points (95% confidence interval [CI]: -4.9 to -.8, P = .007) and was the only predictor of independency (mRS score 0-2) following adjustment for covariates (odds ratio 1.15, 95% CI: 1.04-1.28, P = .005).
  
  
  CONCLUSIONS
  PCT provides accurate markers of viability of tissue in acute ischemic stroke and could help predict the degree of improvement following reperfusion.
authors: Department of Neurology Stroke Center, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Neurology Stroke Center, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors: Michal M
authors: MM
authors: Kawiorski
authors: Department of Radiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
authors: Agustina
authors: A
authors: Vicente
authors: Department of Radiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
authors: Daniel
authors: D
authors: Lourido
authors: Department of Clinical Biostatistics, University Hospital Ramón y Cajal, CIBERESP, IRYCIS, Madrid, Spain.
authors: Alfonso
authors: A
authors: Muriel
authors: Department of Radiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
authors: Eduardo
authors: E
authors: Fandiño
authors: Department of Radiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
authors: José C
authors: JC
authors: Méndez
authors: Department of Neurology Stroke Center, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors: Víctor
authors: V
authors: Sánchez-González
authors: Department of Neurology Stroke Center, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors: Alba
authors: A
authors: Aguado
authors: Department of Neurology Stroke Center, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors: Rodrigo
authors: R
authors: Álvarez-Velasco
authors: Department of Neurology Stroke Center, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Neurology Stroke Center, University Hospital La Paz, IdiPAZ, Madrid, Spain. Electronic address: malecinanacases@salud.madrid.org.
authors: María
authors: M
authors: Alonso de Leciñana
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D015424:Reperfusion; D012189:Retrospective Studies; D014022:Tissue Survival; D016896:Treatment Outcome
keywords: Perfusion computed tomography; endovascular treatment; ischemic penumbra; ischemic stroke; mechanical thrombectomy; reperfusion; thrombolysis