Abstract:
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Purpose: To evaluate the feasibility and prognostic accuracy of penumbra
assessment by perfusion-CT before intravenous thrombolytic treatment within 3
hours of stroke onset.
Methods and Materials: Viable ischemic tissue and infarct were assessed on
admission by perfusion-CT, with measurement of the penumbra
volume/penumbra+infarct volume ratio (Lausanne Stroke Index LSI). Perfusion-CT
was followed by CT-angiography (CTA) to assess vessel patency, both
examinations being performed before intravenous thrombolytic treatment with
rtPA. Diffusion-weighted imaging (DWI) and MR-angiography (MRA) were obtained
within 6 hours and 4 days later.
Results: Thrombolytic treatment was initiated within 148+-30 minutes in 35
patients, while perfusion-CT and CTA were performed within 114+-45 minutes of
stroke onset. Penumbra was found in 31 (89%) patients (mean LSI = 66%+-23%) and
internal carotid artery/middle cerebral artery occlusion in 27 (77%). Fourteen
patients (40%) had a favorable outcome (3-month NIHSS <=1), with arterial
reopening on MRA in over half the patients (57%; positive predictor of outcome,
multivariate analysis: p=0.001). A strong correlation was found between
admission penumbra (mean LSI, 73%+-18%) and 24-hour NIHSS improvement
(70.5%+-16.5%; p<0.001), with equivalent perfusion-CT-predicted infarct and
final DWI infarct.
Conclusion: Viable tissue versus predicted infarct can be measured by
perfusion-CT within 3 hours of stroke onset and before intravenous
thrombolysis, allowing early prediction of clinical improvement and infarct
size associated with arterial reopening. (Philips Medical Systems collaborated
in the development of the perfusion-CT software in which data of the study was
processed.)
Questions about this event email: Max_Wintermark@hotmail.com
Wintermark MD, M,
Ischemic Tissue Viability within 3 Hours of Acute Stroke Onset and Before Intravenous Thrombolysis. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3100414.html
