(Stroke. 1996;27:1537-1542.)
© 1996 American Heart Association, Inc.
Articles |
Simple Visual Analysis of Brain Perfusion on HMPAO SPECT Predicts Early Outcome in Acute Stroke
the Stroke Research Unit (A.V.A., S.E.B., C.F.B., L.T.S., A.P.), the Division of Nuclear Medicine (L.E.E.), and the Department of Medical Imaging (C.B.C.), Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Correspondence to Dr A.V. Alexandrov, Stroke Research Unit, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5.
Background and Purpose Single-photon emission computed tomography (SPECT) is used in patients with acute stroke but as yet is of controversial value. We investigated an association of brain perfusion changes in stroke patients with stroke severity, volume of brain damage, and recovery.
Methods Consecutive patients with hemispheric stroke were studied prospectively with serial neurological examinations using the Canadian Neurological Scale (CNS), CT, and 99mTc–hexamethylpropyleneamine oxime (HMPAO) SPECT. Visual SPECT patterns of brain perfusion (normal, high, mixed, low, and absent) were correlated with the severity of stroke, lesion volume, and short-term outcome.
Results SPECT studies were performed in a total of 458 consecutive acute stroke patients within 2 weeks after the onset (mean time, 5 days; range, 1 to 12 days). SPECT perfusion patterns correlated with stroke severity (CNS score) during the first 2 weeks (P<.001). Focal absence of brain perfusion on SPECT was associated with the largest volume of brain damage: 104±84 mL (P<.0001). SPECT perfusion patterns predicted the short-term outcome: 97% of patients with normal and increased HMPAO uptake made good recovery, 52% of those with decreased perfusion had moderate stroke, and 62% of patients with absent patterns fared badly. In a multiple logistic regression model, admission CNS scores had the strongest predictive value (P=.0001). SPECT had its own prognostic value independent of clinical judgment (P=.03). SPECT statistically improved predictive power of the CNS score (+1% receiver operating characteristic curve area, [
2]2=20, P<.001) because of distinction between focal decrease or absence of brain perfusion in patients studied within the first 72 hours of stroke.
Conclusions Visual brain perfusion patterns correlate with the extent, severity, and short-term outcome of hemispheric stroke. HMPAO SPECT may improve the prognostic value of clinical examination if performed during the first 72 hours of stroke.
Key Words: prognosis • stroke assessment • tomography, emission computed
This article has been cited by other articles:
 |
|
 |
|
  M. Wintermark, M. Sesay, E. Barbier, K. Borbely, W. P. Dillon, J. D. Eastwood, T. C. Glenn, C. B. Grandin, S. Pedraza, J.-F. Soustiel, et al. Comparative Overview of Brain Perfusion Imaging Techniques Stroke, September 1, 2005; 36(9): e83 - e99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Latchaw, H. Yonas, G. J. Hunter, W. T.C. Yuh, T. Ueda, A. G. Sorensen, J. L. Sunshine, J. Biller, L. Wechsler, R. Higashida, et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association Stroke, April 1, 2003; 34(4): 1084 - 1104. [Full Text] [PDF]
|
|
|
|
|
|
D. G. Nabavi, S. P. Kloska, E.-M. Nam, M. Freund, C. G. Gaus, E. Klotz, W. Heindel, and E. B. Ringelstein MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: Novel Diagnostic Approach for the Prediction of Infarction Size and Clinical Outcome Stroke, December 1, 2002; 33(12): 2819 - 2826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. U. Harrer and C. Klotzsch Second Harmonic Imaging of the Human Brain: The Practicability of Coronal Insonation Planes and Alternative Perfusion Parameters Stroke, June 1, 2002; 33(6): 1530 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Sugawara, T. Ueda, T. Kikuchi, N. Yamamoto, Y. Semba, S. Nakata, T. Mochizuki, and J. Ikezoe Hyperactivity of 99mTc-HMPAO Within 6 Hours in Patients with Acute Ischemic Stroke J. Nucl. Med., September 1, 2001; 42(9): 1297 - 1302. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Barthel, S. Hesse, C. Dannenberg, A. Rossler, D. Schneider, W. H. Knapp, J. Dietrich, and J. Berrouschot Prospective Value of Perfusion and X-Ray Attenuation Imaging With Single-Photon Emission and Transmission Computed Tomography in Acute Cerebral Ischemia Stroke, July 1, 2001; 32(7): 1588 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. Camargo Brain SPECT in Neurology and Psychiatry J. Nucl. Med., April 1, 2001; 42(4): 611 - 623. [Abstract] [Full Text]
|
|
|
|
|
|
A. M. Catafau Brain SPECT in Clinical Practice. Part I: Perfusion J. Nucl. Med., February 1, 2001; 42(2): 259 - 271. [Abstract] [Full Text]
|
|
|
|
 |
|
 J Federlein, T. Postert, S Meves, S Weber, H Przuntek, and T. Buttner Ultrasonic evaluation of pathological brain perfusion in acute stroke using second harmonic imaging J. Neurol. Neurosurg. Psychiatry, November 1, 2000; 69(5): 616 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Umemura, T. Suzuka, and K. Yamada Quantitative measurement of cerebral blood flow by 99mTc-HMPAO SPECT in acute ischaemic stroke: usefulness in determining therapeutic options J. Neurol. Neurosurg. Psychiatry, October 1, 2000; 69(4): 472 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. Mayer, G. F. Hamann, J. Baranczyk, B. Rosengarten, E. Klotz, M. Wiesmann, U. Missler, G. Schulte-Altedorneburg, and H. J. Brueckmann Dynamic CT Perfusion Imaging of Acute Stroke AJNR Am. J. Neuroradiol., August 1, 2000; 21(8): 1441 - 1449. [Abstract] [Full Text]
|
|
|
|
|
|
T. Ueda, S. Sakaki, Y. Kumon, and S. Ohta Multivariable Analysis of Predictive Factors Related to Outcome at 6 Months After Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, November 1, 1999; 30 (11): 2360 - 2365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T.F. Cheung, P. A. Barber, and S. M. Davis Single-Photon Emission Computed Tomography–Derived Relative Hypoperfusion Volume After Ischemic Stroke • Response Stroke, August 1, 1999; 30(8): 1733 - 1734. [Full Text] [PDF]
|
|
|
|
|
|
R. T. F. Cheung, S. A. Mayer, and R. L. Van Heertum SPECT-Derived Relative Perfusion Defect and CT-Derived Hypodense Region in Acute Intracerebral Hemorrhage • Response Stroke, July 1, 1999; 30 (7): 1490 - 1493. [Full Text] [PDF]
|
|
|
|
|
|
J. Juni and Spicer Paradoxical Hyperfixation of HMPAO in Cerebral AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 732 - 733. [Full Text]
|
|
|
|
|
|
J. Berrouschot, H. Barthel, J. Koster, S. Hesse, A. Rossler, W. H. Knapp, and D. Schneider Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke : A Randomized Pilot Study Stroke, April 1, 1999; 30(4): 787 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cenic, D. G. Nabavi, R. A. Craen, A. W. Gelb, and T.-Y. Lee Dynamic CT Measurement of Cerebral Blood Flow: A Validation Study AJNR Am. J. Neuroradiol., January 1, 1999; 20(1): 63 - 73. [Abstract] [Full Text]
|
|
|
|
|
|
J V Bowler, J P H Wade, B E Jones, K S Nijran, and T J Steiner Natural history of the spontaneous reperfusion of human cerebral infarcts as assessed by 99mTc HMPAO SPECT J. Neurol. Neurosurg. Psychiatry, January 1, 1998; 64(1): 90 - 97. [Abstract] [Full Text]
|
|
|
|
|
|
A. V. Alexandrov, J. C. Masdeu, M. D. Devous Sr, S. E. Black, and J. C. Grotta Brain Single-Photon Emission CT With HMPAO and Safety of Thrombolytic Therapy in Acute Ischemic Stroke : Proceedings of the Meeting of the SPECT Safe Thrombolysis Study Collaborators and the Members of the Brain Imaging Council of the Society of Nuclear Medicine Stroke, September 1, 1997; 28(9): 1830 - 1834. [Abstract] [Full Text]
|
|
|
|
|
|
A. V. Alexandrov, S. E. Black, L. E. Ehrlich, C. B. Caldwell, and J. W. Norris Predictors of Hemorrhagic Transformation Occurring Spontaneously and on Anticoagulants in Patients With Acute Ischemic Stroke Stroke, June 1, 1997; 28(6): 1198 - 1202. [Abstract] [Full Text]
|
|