Pamela Schaefer MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: CT perfusion (CTP) imaging reflects neurophysiologic changes during stroke evolution. We sought to determine parameters that distinguish brain regions destined to infarct from those that will survive despite hypoperfusion in patients treated with intra-arterial (IA) reperfusion therapy Methods and Materials: CTP images were obtained in 9 patients with proximal MCA emboli treated with IA reperfusion therapy (thrombolysis and/or clot retrieval) within six hours. CBV and CBF values were obtained in the entire 1) infarct core with low CBV, low CBF and follow-up abnormality, 2) penumbra that infarcts with normal CBV, low CBF and follow-up abnormality and 3) penumbra that remains viable with normal CBV, low CBF and normal follow-up. CBF values were also obtained in small ROIs placed within gray matter (GM) or white matter (WM). Results: Mean CBF values for GM in regions 1, 2 and 3 were 13.2, 19.5 and 29.6 ml/100 gm/min, respectively. Regions 2 and 3 were significantly different (p<0.05). Mean CBF values for WM in regions 1, 2 and 3 were 4.49, 9.5 and 10.6 ml/100 gm/min, respectively. Mean CBF values for all tissue in regions 1, 2 and 3 were 5.35, 15.6 and 16.25 ml/100 gm/min, respectively. Mean CBV values for all tissue in regions 1, 2 and 3 were 1.00, 2.3 and 2.4 ml/100 gm, respectively. For WM CBF, all tissue CBF and CBV, regions 2 and 3 were not significantly different (p>0.05). No GM ROI with CBF < 11.86 ml/100gm/min, no WM ROI with CBF < 3.07 ml/100gm/min and no ROI with CBV < 1.5 ml/100 gm remained viable. No GM ROI with CBF > 32.4 ml/100gm/min and no WM ROI with CBF >18.4 ml/100gm/min infarcted. Conclusion: CBF GM values are useful in distinguishing hypoperfused tissue likely to infarct from tissue likely to survive with IA reperfusion therapy. Other CBF and CBV values may provide adjunctive information.This information may be useful in differentiating patients likely to benefit from reperfusion therapy from those who are not.       Questions about this event email: pschaefer@partners.org

Schaefer MD, P, Assessment of Tissue Viability with Quantitative CT Perfusion in Acute Ischemic Stroke Patients Treated with Intra-Arterial Thrombolysis.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3107687.html