Hemodynamic assessment of acute stroke using dynamic single-slice computedtomographic perfusion imaging

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.