title: CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy.
abstract: In this study, we determined whether a prediction of final infarct volume (FIV) and clinical outcomes in patients with an acute stroke is improved by using a contrast transfer coefficient (Ktrans) as a biomarker for blood-brain barrier (BBB) dysfunction. Here, consecutive patients admitted with signs and symptoms suggesting acute hemispheric stroke were included in this study. Ninety-eight participants with intra-arterial therapy were assessed (46 female). Definition of predicted FIV was performed using conventional perfusion CT (PCT-PIV) parameters alone and in combination with Ktrans(Ktrans-PIV). Multiple logistic regression analyses and linear regression modeling were conducted to determine independent predictors of the 90-day modified Rankin score (mRS) and FIV, respectively. We found that patients with favorable outcomes were younger and had lower National Institutes of Health Stroke Scale (NIHSS) score, smaller PCT-PIV, Ktrans-PIV, and smaller FIV (P < 0.001). Ktrans-PIV showed good correlation with FIV (P < 00.001, R2= 0.6997). In the regression analyses, Ktrans-PIV was the best predictor of clinical outcomes (P = 0.009, odds ratio (OR) = 1.960) and also the best predictor for FIV (F = 75.590, P < 0.0001). In conclusion, combining PCT and Ktransmaps derived from first-pass PCT can identify at-risk cerebral ischemic tissue more precisely than perfusion parameters alone. This provides improved accuracy in predicting FIV and clinical outcomes.
authors.affiliation: Third Military Medical University, Chongqing, 400038, China.|Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Radiology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Neuroradiology Section, Department of Radiology, Stanford University, Stanford, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Jackson
authors.affiliation: Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
authors.forename: Yongwei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: GE Healthcare, Beijing, China.
authors.forename: Zihua
authors.initials: Z
authors.lastname: Su
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China. zhugmdc@aliyun.com.
authors.forename: Guangming
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China. zhangvivian@vip.sina.com.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D010539:Permeability; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Benign oligemia; Blood–brain barrier dysfunction; Perfusion; Permeability