SIMPLE VISUAL ANALYSIS OF BRAIN PERFUSION ON HMPAO SPECT PREDICTS EARLY OUTCOME IN ACUTE STROKE

Background and Purpose Single-photon emission computed tomography (SPE CT) is used in patients with acute stroke but as yet is of controversi al value. We investigated an association of brain perfusion changes in stroke patients with stroke severity, volume of brain damage, and rec overy. Methods Consecutive patients with hemispheric stroke were studi ed prospectively with serial neurological examinations using the Canad ian Neurological Scale (CNS), CT, and Tc-99m-hexamethylpropyleneamine oxime (HMPAO) SPECT. Visual SPECT patterns of brain perfusion (normal, high, mixed, low, and absent) were correlated with the severity of st roke, lesion volume, and short-term outcome. Results SPECT studies wer e performed in a total of 458 consecutive acute stroke patients within 2 weeks after the onset (mean time, 5 days; range, 1 to 12 days). SPE CT perfusion patterns correlated with stroke severity (CNS score) duri ng the first 2 weeks (P<.001). Focal absence of brain perfusion on SPE CT was associated with the largest volume of brain damage: 104 +/- 84 mt (P<.0001). SPECT perfusion patterns predicted the short-term outcom e: 97% of patients with normal and increased HMPAO uptake made good re covery, 52% of those with decreased perfusion had moderate stroke, and 62% of patients with absent patterns fared badly. In a multiple logis tic regression model, admission CNS scores had the strongest predictiv e value (P=.0001). SPECT had its own prognostic value independent of c linical judgment (P=.03). SPECT statistically improved predictive powe r of the CNS score (+1% receiver operating characteristic curve area, [chi(2)](2)=20, P<.001) because of distinction between focal decrease or absence of brain perfusion in patients studied within the first 72 hours of stroke. Conclusions Visual brain perfusion patterns correlate with the extent, severity, and short-term outcome of hemispheric stro ke. HMPAO SPECT may improve the prognostic value of clinical examinati on if performed during the first 72 hours of stroke.