J. Rother et al., Hemodynamic assessment of acute stroke using dynamic single-slice computedtomographic perfusion imaging, ARCH NEUROL, 57(8), 2000, pp. 1161-1166
Background: Stroke management would benefit from a broadly available imagin
g tool that detects perfusion deficits in patients with acute stroke.
Objective: To determine the role of dynamic, single-slice computed tomograp
hic (CT) perfusion imaging (CTP) in the assessment of acute middle cerebral
artery stroke.
Design and Patients; Imaging with CTP and CT within the first 6 hours of sy
mptom onset and before the start of treatment ill a consecutive clinical se
ries of 22 patients (mean age, 68.3 years, 14 women; studied within 143 +/-
96 minutes of stroke onset).
Setting: A stroke unit in a university hospital.
Main Outcome Measures? Area of the perfusion deficit (nAP(0)) from time-to-
peak maps, hemispheric lesion area from follow-up CT (HLA(r)), final infarc
t volume, and stroke recovery (National Institutes of Health Stroke Scale s
cores).
Results: Eighteen patients had perfusion deficits in the middle cerebral ar
tery territory and corresponding hypoattenuation in follow-up CT. Three pat
ients with normal CTP findings showed lacunar infarctions or normal finding
s on follow-up CT. In 1 patient, CTP did not reveal a territorial deficit a
bove the imaging slice. The overall sensitivity and specificity of CTP for
the detection of perfusion deficits in patients with proven territorial inf
arction (n=18) on follow-up CT were 95% and 100%, respectively. The nAP(0)
was significantly correlated with the National Institutes of Health Stroke
Scale score at admission (P<.003) and the HLA(F) (P<.001). Different stroke
patterns were identified in patients with follow-up CTP (n=10): (1) initia
l perfusion deficit and partial nutritional reperfusion (nAP(0)>HLA(F); n=6
), (2) initial perfusion deficit and nonnutritional reperfusion (nAP(0)grea
ter than or equal to HLA(F); n=2), and (3) initial perfusion deficit withou
t reperfusion (nAP(0)greater than or equal to HLA(F); n=2).
Conclusions: Computed tomographic perfusion imaging detects major perfusion
deficits in the middle cerebral artery territory. Because CTP is broadly a
vailable, it may play a role in acute stroke management.