title: Quantifying reperfusion of the ischemic region on whole-brain computed tomography perfusion.
abstract: To derive the reperfusion index best predicting clinical outcome of ischemic stroke patients, we retrospectively analysed the acute and 24-h computed tomography perfusion data of 116 patients, collected from two centres equipped with whole-brain computed tomography perfusion. Reperfusion index was defined by the percentage of the ischemic region reperfused from acute to 24-h computed tomography perfusion. Recanalization was graded by arterial occlusive lesion system. Receiver operator characteristic analysis was performed to assess the prognostic value of reperfusion and recanalization in predicting good clinical outcome, defined as modified Rankin Score of 0-2 at 90 days. Among previous reported reperfusion measurements, reperfusion of the Tmax>6 s region resulted in higher prognostic value than recanalization at predicting good clinical outcome (area under the curve = 0.88 and 0.74, respectively, p = 0.002). Successful reperfusion of the Tmax>6 s region (≥60%) had 89% sensitivity and 78% specificity in predicting good clinical outcome. A reperfusion index defined by Tmax>2 s or by mean transit time>145% had much lower area under the curve in comparison to Tmax>6 s measurement (p < 0.001 and p = 0.003, respectively), and had no significant difference to recanalization at predicting clinical outcome (p = 0.58 and 0.63, respectively). In conclusion, reperfusion index calculated by Tmax>6 s is a stronger predictor of clinical outcome than recanalization or other reperfusion measures.
authors.affiliation: 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.
authors.forename: Longting
authors.initials: L
authors.lastname: Lin
authors.affiliation: 3 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Cheng
authors.affiliation: 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
authors.affiliation: 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.|2 Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Levi
authors.affiliation: 3 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
authors.affiliation: 1 School of Medicine and Public health, University of Newcastle, Newcastle, Australia.|2 Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
mesh_terms: D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D000072226:Computed Tomography Angiography / Q000379:methods*; D006801:Humans; D015424:Reperfusion; D012189:Retrospective Studies
keywords: Acute stroke; brain imaging; brain ischemia; cerebral blood flow measurement; reperfusion