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(Stroke. 1999;30:389-392.)
© 1999 American Heart Association, Inc.
Original Contributions |
Evaluation of Early Computed Tomographic Findings in Acute Ischemic Stroke
From Stanford University, Stanford, Calif (M.P.M.); Genentech, South San Francisco, Calif (E.B.H., J.F.); University of Western Ontario, London, Ontario, Canada (A.J.F.); Henry Ford Hospital, Detroit, Mich (S.P) ; and the University of Dresden (R.von K.), Dresden, Germany.
Correspondence and reprint requests to Michael P. Marks, MD, Director of Neuroradiology, Stanford Stroke Center, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105. E-mail: m.marks{at}stanford.edu
Background and Purpose—Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome.
Methods—Fifty hyperacute CT scans (<6 hours after ictus) were selected from a randomized trial evaluating IV-tPA (ATLANTIS trial). Three neuroradiologists blinded to all clinical information evaluated scans for degree of MCA territory involvement (<33% or >33%) and the presence of a hyperdense MCA. Evaluations were compared with 24-hour scan results, 30-day infarct volumes, and baseline NIH stroke scale scores (NIHSS).
Results—Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlation=0.53, P<0.001), with all 3 readers agreeing in 36 of 50 cases (72%). They correctly called >33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when >33% MCA hypodensity was seen (P=0.021). Detection of significant hypodensity (>33%) correlated with poorer outcome. When >33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm3, versus 84.3 to 123.1 cm3 when >33% hypodensity was present (P=0.002).
Conclusions—Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction.
Key Words: cerebral infarction • cerebral ischemia • tomography, x-ray computed
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