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Multiphasic perfusion CT in acute middle cerebral artery ischemic stroke: prediction of final infarct volume and correlation with clinical outcome.

Yi CA, Na DG, Ryoo JW, Moon CH, Byun HS, Roh HG, Moon WJ, Lee KH, Lee SJ - Korean J Radiol (2002 Jul-Sep)

Bottom Line: After baseline unenhanced helical CT scanning, contrast-enhanced CT scans were obtained 20, 34, 48, and 62 secs after the injection of 90 mL contrast medium at a rate of 3 mL/sec.The lesion volumes depicted by CT maps showed moderate correlation with baseline clinical scores and clinical outcomes (R=0.445-0.706, p< or = 0.007).The lesion volume seen on CT maps shows moderate correlation with clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess the utility of multiphasic perfusion CT in the prediction of final infarct volume, and the relationship between lesion volume revealed by CT imaging and clinical outcome in acute ischemic stroke patients who have not undergone thrombolytic therapy.

Materials and methods: Thirty-five patients underwent multiphasic perfusion CT within six hours of stroke onset. After baseline unenhanced helical CT scanning, contrast-enhanced CT scans were obtained 20, 34, 48, and 62 secs after the injection of 90 mL contrast medium at a rate of 3 mL/sec. CT peak and total perfusion maps were obtained from serial CT images, and the initial lesion volumes revealed by CT were compared with final infarct volumes and clinical scores.

Results: Overall, the lesion volumes seen on CT peak perfusion maps correlated most strongly with final infarct volumes (R(2)=0.819, p<0.001, slope of regression line=1.016), but individual data showed that they were less than final infarct volume in 31.4% of patients. In those who showed early clinical improvement (n=6), final infarct volume tended to be overestimated by CT peak perfusion mapping and only on total perfusion maps was there significant correlation between lesion volume and final infarct volume (R(2)=0.854, p=0.008). The lesion volumes depicted by CT maps showed moderate correlation with baseline clinical scores and clinical outcomes (R=0.445-0.706, p< or = 0.007).

Conclusion: CT peak perfusion maps demonstrate strong correlation between lesion volume and final infarct volume, and accurately predict final infarct volume in about two-thirds of the 35 patients. The lesion volume seen on CT maps shows moderate correlation with clinical outcome.

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Overall correlation between initial lesion volume and final infarct at unenhanced CT, and on CT peak and total perfusion maps. The relationship between initial lesion and final infarct volume was strongest on CT peak perfusion maps (R2=0.819), followed by CT total perfusion maps (R2=0.797) and unenhanced CT (R2=0.641). CT peak perfusion maps showed that initial lesion volume was slightly less than final infarct volume (slope of regression line=1.016), while CT total perfusion maps and unenhanced CT showed it as significantly less (slope of regression line=1.246 and 1.523, respectively).
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Figure 1: Overall correlation between initial lesion volume and final infarct at unenhanced CT, and on CT peak and total perfusion maps. The relationship between initial lesion and final infarct volume was strongest on CT peak perfusion maps (R2=0.819), followed by CT total perfusion maps (R2=0.797) and unenhanced CT (R2=0.641). CT peak perfusion maps showed that initial lesion volume was slightly less than final infarct volume (slope of regression line=1.016), while CT total perfusion maps and unenhanced CT showed it as significantly less (slope of regression line=1.246 and 1.523, respectively).

Mentions: Table 1 shows the relationship between initial lesion volumes at CT imaging and follow-up infarct volumes; scatter-plots of each data set are shown in Figure 1. Overall, there was significant correlation between initial lesion volume and final infarct volume, as seen at unenhanced CT and on CT peak and total perfusion maps. The initial lesion volume seen on CT peak perfusion maps correlated most strongly with final infarct volume measured at either follow-up unenhanced CT or MRI (R2=0.819, p<0.001) and tended to be similar to final infarct volume (slope of regression line, 1.016) (Fig. 2). Meanwhile, final infarct volumes were significantly underestimated by total perfusion mapping and unenhanced CT (slope of regression lines, 1.246 and 1.523, respectively), as demonstrated by Figure 3. The mismatch between lesion volume at unenhanced CT and on CT peak perfusion maps correlated significantly with the volume of infarct growth (R=0.756, R2=0.572, p<0.001), showing, overall, a mean value slightly less than this (43.89 ± 42.01 vs. 50.45 ± 39.38, respectively) but slightly more than final infarct volume (slope of regression line=0.942).


Multiphasic perfusion CT in acute middle cerebral artery ischemic stroke: prediction of final infarct volume and correlation with clinical outcome.

Yi CA, Na DG, Ryoo JW, Moon CH, Byun HS, Roh HG, Moon WJ, Lee KH, Lee SJ - Korean J Radiol (2002 Jul-Sep)

Overall correlation between initial lesion volume and final infarct at unenhanced CT, and on CT peak and total perfusion maps. The relationship between initial lesion and final infarct volume was strongest on CT peak perfusion maps (R2=0.819), followed by CT total perfusion maps (R2=0.797) and unenhanced CT (R2=0.641). CT peak perfusion maps showed that initial lesion volume was slightly less than final infarct volume (slope of regression line=1.016), while CT total perfusion maps and unenhanced CT showed it as significantly less (slope of regression line=1.246 and 1.523, respectively).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713880&req=5

Figure 1: Overall correlation between initial lesion volume and final infarct at unenhanced CT, and on CT peak and total perfusion maps. The relationship between initial lesion and final infarct volume was strongest on CT peak perfusion maps (R2=0.819), followed by CT total perfusion maps (R2=0.797) and unenhanced CT (R2=0.641). CT peak perfusion maps showed that initial lesion volume was slightly less than final infarct volume (slope of regression line=1.016), while CT total perfusion maps and unenhanced CT showed it as significantly less (slope of regression line=1.246 and 1.523, respectively).
Mentions: Table 1 shows the relationship between initial lesion volumes at CT imaging and follow-up infarct volumes; scatter-plots of each data set are shown in Figure 1. Overall, there was significant correlation between initial lesion volume and final infarct volume, as seen at unenhanced CT and on CT peak and total perfusion maps. The initial lesion volume seen on CT peak perfusion maps correlated most strongly with final infarct volume measured at either follow-up unenhanced CT or MRI (R2=0.819, p<0.001) and tended to be similar to final infarct volume (slope of regression line, 1.016) (Fig. 2). Meanwhile, final infarct volumes were significantly underestimated by total perfusion mapping and unenhanced CT (slope of regression lines, 1.246 and 1.523, respectively), as demonstrated by Figure 3. The mismatch between lesion volume at unenhanced CT and on CT peak perfusion maps correlated significantly with the volume of infarct growth (R=0.756, R2=0.572, p<0.001), showing, overall, a mean value slightly less than this (43.89 ± 42.01 vs. 50.45 ± 39.38, respectively) but slightly more than final infarct volume (slope of regression line=0.942).

Bottom Line: After baseline unenhanced helical CT scanning, contrast-enhanced CT scans were obtained 20, 34, 48, and 62 secs after the injection of 90 mL contrast medium at a rate of 3 mL/sec.The lesion volumes depicted by CT maps showed moderate correlation with baseline clinical scores and clinical outcomes (R=0.445-0.706, p< or = 0.007).The lesion volume seen on CT maps shows moderate correlation with clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess the utility of multiphasic perfusion CT in the prediction of final infarct volume, and the relationship between lesion volume revealed by CT imaging and clinical outcome in acute ischemic stroke patients who have not undergone thrombolytic therapy.

Materials and methods: Thirty-five patients underwent multiphasic perfusion CT within six hours of stroke onset. After baseline unenhanced helical CT scanning, contrast-enhanced CT scans were obtained 20, 34, 48, and 62 secs after the injection of 90 mL contrast medium at a rate of 3 mL/sec. CT peak and total perfusion maps were obtained from serial CT images, and the initial lesion volumes revealed by CT were compared with final infarct volumes and clinical scores.

Results: Overall, the lesion volumes seen on CT peak perfusion maps correlated most strongly with final infarct volumes (R(2)=0.819, p<0.001, slope of regression line=1.016), but individual data showed that they were less than final infarct volume in 31.4% of patients. In those who showed early clinical improvement (n=6), final infarct volume tended to be overestimated by CT peak perfusion mapping and only on total perfusion maps was there significant correlation between lesion volume and final infarct volume (R(2)=0.854, p=0.008). The lesion volumes depicted by CT maps showed moderate correlation with baseline clinical scores and clinical outcomes (R=0.445-0.706, p< or = 0.007).

Conclusion: CT peak perfusion maps demonstrate strong correlation between lesion volume and final infarct volume, and accurately predict final infarct volume in about two-thirds of the 35 patients. The lesion volume seen on CT maps shows moderate correlation with clinical outcome.

Show MeSH
Related in: MedlinePlus