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Prediction of clinical outcome with baseline and 24-hour perfusion CT in acute middle cerebral artery territory ischemic stroke treated with intravenous recanalization therapy

  • Diagnostic Neuroradiology
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Abstract

Introduction

We sought to determine whether Alberta Stroke Program Early CT Scores (ASPECTS) derived from baseline noncontrast CT (NCCT) and perfusion CT (CTP) imaging maps can predict clinical outcome after recanalization therapy in acute ischemic stroke of the middle cerebral artery (MCA) territory and whether changes in the ASPECTS from baseline to 24 h after recanalization therapy can help predict clinical outcome.

Methods

We retrospectively studied consecutive patients with acute ischemic stroke of the MCA territory treated with intravenous tissue plasminogen activator (t-PA) or abciximab within 6 h of symptom onset. We performed NCCT and CTP before and 24 h after intravenous t-PA or abciximab treatment and determined the ASPECTS and the changes in the ASPECTS from baseline to 24 h. A favorable outcome was defined as a modified Rankin scale score of 0 or 1 at 3 months.

Results

During the 18-month study period 44 patients were studied. In multivariate logistic regression analysis, the cerebral blood volume (CBV) ASPECTS (OR 1.80, 95% CI 1.10 to 2.93) at baseline and the increase in cerebral blood flow (CBF) ASPECTS (OR 1.68, 95% CI 1.13 to 2.50) from baseline to 24 h were associated with a favorable outcome. The cutoff values for a favorable outcome using receiver operating characteristic curves were 8 and 1, respectively. When the CBV ASPECTS at baseline was 8 or more, its positive predictive value was only 58.1%. When the CBV ASPECTS at baseline was 8 or more and the increase in CBF ASPECTS from baseline to 24 h was 1 or more, the positive predictive value was 100% and the negative predictive value was 74.2%.

Conclusion

The CBV ASPECTS derived from baseline CTP maps was found to be predictive of a favorable outcome, but its positive predictive value was suboptimal. The change in the CBF ASPECTS from baseline to 24 h after treatment was helpful in predicting outcome.

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References

  1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  2. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282:2003–2011

    Article  PubMed  CAS  Google Scholar 

  3. Abciximab Emergent Stroke Treatment Trial (AbESTT) Investigators (2005) Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of a randomized phase 2 trial. Stroke 36:880–890

    Article  CAS  Google Scholar 

  4. Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J, Meuli R (2002) Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 51:417–432

    Article  PubMed  Google Scholar 

  5. Schramm P, Schellinger PD, Klotz E, Kallenberg K, Fiebach JB, Külkens S, Heiland S, Knauth M, Sartor K (2004) Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke 35:1652–1658

    Article  PubMed  Google Scholar 

  6. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355:1670–1674

    Article  PubMed  CAS  Google Scholar 

  7. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, Hu WY, Buchan AM (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22:1534–1542

    PubMed  CAS  Google Scholar 

  8. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708

    PubMed  CAS  Google Scholar 

  9. Parsons MW, Pepper EM, Chan V, Siddique S, Rajaratnam S, Bateman GA, Levi CR (2005) Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol 58:672–679

    Article  PubMed  Google Scholar 

  10. Demchuk AM, Tanne D, Hill MD, Kasner SE, Hanson S, Grond M, Levine SR, Multicentre tPA Stroke Survey Group (2001) Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 57:474–480

    PubMed  CAS  Google Scholar 

  11. Lyden P (2003) Early major ischemic changes on computed tomography should not preclude use of tissue plasminogen activator. Stroke 34:821–822

    Article  PubMed  Google Scholar 

  12. von Kummer R (2003) Early major ischemic changes on computed tomography should preclude use of tissue plasminogen activator. Stroke 34:820–821

    Article  Google Scholar 

  13. Patel SC, Levine SR, Tilley BC, Grotta JC, Lu M, Frankel M, Haley EC Jr, Brott TG, Broderick JP, Horowitz S, Lyden PD, Lewandowski CA, Marler JR, Welch KM, National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (2001) Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. JAMA 286:2830–2838

    Article  PubMed  CAS  Google Scholar 

  14. von Kummer R, Bourquain H, Bastianello S, Bozzao L, Manelfe C, Meier D, Hacke W (2001) Early prediction of irreversible brain damage after ischemic stroke at CT. Radiology 219:95–100

    Google Scholar 

  15. Na DG, Kim EY, Ryoo JW, Lee KH, Roh HG, Kim SS, Song IC, Chang KH (2005) CT sign of brain swelling without concomitant parenchymal hypoattenuation: comparison with diffusion- and perfusion-weighted MR imaging. Radiology 235:992–998

    Article  PubMed  Google Scholar 

  16. Butcher KS, Lee SB, Parsons MW, Allport L, Fink J, Tress B, Donnan G, Davis SM, EPITHET Investigators (2007) Differential prognosis of isolated cortical swelling and hypoattenuation on CT in acute stroke. Stroke 38:941–947

    Article  PubMed  Google Scholar 

  17. Wintermark M, Reichhart M, Cuisenaire O, Maeder P, Thiran JP, Schnyder P, Bogousslavsky J, Meuli R (2002) Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke 33:2025–2031

    Article  PubMed  CAS  Google Scholar 

  18. Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, Anderson J, Nesbit G, Gabriely I, Medina V, Quiles A, Pohlman S, Quist M, Schnyder P, Bogousslavsky J, Dillon WP, Pedraza S (2006) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 37:979–985

    Article  PubMed  Google Scholar 

  19. Hill MD, Rowley HA, Adler F, Eliasziw M, Furlan A, Higashida RT, Wechsler LR, Roberts HC, Dillon WP, Fischbein NJ, Firszt CM, Schulz GA, Buchan AM, PROACT-II Investigators (2003) Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS. Stroke 34:1925–1931

    Article  PubMed  Google Scholar 

  20. Dzialowski I, Hill MD, Coutts SB, Demchuk AM, Kent DM, Wunderlich O, von Kummer R (2006) Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke 37:973–978

    Article  PubMed  Google Scholar 

  21. Demchuk AM, Hill MD, Barber PA, Silver B, Patel SC, Levine SR (2005) Importance of early ischemic computed tomography changes using aspects in NINDS rtPA Stroke Study. Stroke 36:2110–2115

    Article  PubMed  Google Scholar 

  22. Kloska SP, Dittrich R, Fischer T, Nabavi DG, Fischbach R, Seidensticker P, Osada N, Ringelstein EB, Heindel W (2007) Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy. Eur Radiol 17:2491–2498

    Article  PubMed  Google Scholar 

  23. Aviv RI, Mandelcorn J, Chakraborty S, Gladstone D, Malham S, Tomlinson G, Fox AJ, Symons S (2007) Alberta Stroke Program Early CT Scoring of CT perfusion in early stroke visualization and assessment. AJNR Am J Neuroradiol 28:1975–1980

    Article  PubMed  CAS  Google Scholar 

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, 220-701, South Korea

    Ji-Yong Lee, Seo Hyun Kim, Sang Hyun Park & Sung Soo Lee

  2. Department of Radiology, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, 220-701, South Korea

    Myeong Sub Lee

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  1. Ji-Yong Lee
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Correspondence to Ji-Yong Lee.

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Lee, JY., Kim, S.H., Lee, M.S. et al. Prediction of clinical outcome with baseline and 24-hour perfusion CT in acute middle cerebral artery territory ischemic stroke treated with intravenous recanalization therapy. Neuroradiology 50, 391–396 (2008). https://doi.org/10.1007/s00234-007-0358-2

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  • DOI: https://doi.org/10.1007/s00234-007-0358-2

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