| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(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
This article has been cited by other articles:
 |
|
 |
|
  J. R. Sims, L. R. Gharai, P. W. Schaefer, M. Vangel, E. S. Rosenthal, M. H. Lev, and L. H. Schwamm ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes Neurology, June 16, 2009; 72(24): 2104 - 2110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Mahajan, P.T. Minshew, J. Khoury, P.P. Shu, M. Muzaffar, T. Abruzzo, J.L. Leach, and T.A. Tomsick Eye Position Information on CT Increases the Identification of Acute Ischemic Hypoattenuation AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1144 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bisdas, P. Therapidis, J. M. Kerl, N. Papadopoulos, I. Burck, C. Herzog, and T. J. Vogl Value of cerebral perfusion computed tomography in the management of intensive care unit patients with suspected ischaemic cerebral pathology after cardiac surgery Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 521 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Wardlaw and O. Mielke Early Signs of Brain Infarction at CT: Observer Reliability and Outcome after Thrombolytic Treatment--Systematic Review Radiology, May 1, 2005; 235(2): 444 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Provenzale, R. Jahan, T. P. Naidich, and A. J. Fox Assessment of the Patient with Hyperacute Stroke: Imaging and Therapy Radiology, November 1, 2003; 229(2): 347 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. K.F. Mak, K. K.W. Yau, P.-L. Khong, A. S.C. Ching, P.-W. Cheng, P. K.M. Au-Yeung, P. K.M. Pang, K. C.W. Wong, and B. P.L. Chan Hypodensity of >1/3 Middle Cerebral Artery Territory Versus Alberta Stroke Programme Early CT Score (ASPECTS): Comparison of Two Methods of Quantitative Evaluation of Early CT Changes in Hyperacute Ischemic Stroke in the Community Setting Stroke, May 1, 2003; 34(5): 1194 - 1196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Wardlaw, T M West, P A G Sandercock, S C Lewis, and O Mielke Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation J. Neurol. Neurosurg. Psychiatry, April 1, 2003; 74(4): 452 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
J. Rother, P.D. Schellinger, A. Gass, M. Siebler, A. Villringer, J.B. Fiebach, J. Fiehler, O. Jansen, T. Kucinski, V. Schoder, et al. Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours Stroke, October 1, 2002; 33(10): 2438 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kucinski, O. Vaterlein, V. Glauche, J. Fiehler, E. Klotz, B. Eckert, C. Koch, J. Rother, and H. Zeumer Correlation of Apparent Diffusion Coefficient and Computed Tomography Density in Acute Ischemic Stroke Stroke, July 1, 2002; 33(7): 1786 - 1791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Roberts, W. P. Dillon, A. J. Furlan, L. R. Wechsler, H. A. Rowley, N. J. Fischbein, R. T. Higashida, C. Kase, G. A. Schulz, Y. Lu, et al. Computed Tomographic Findings in Patients Undergoing Intra-arterial Thrombolysis for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: Results From the PROACT II Trial * Editorial Comment: Results From the PROACT II Trial Stroke, June 1, 2002; 33(6): 1557 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Patel, S. R. Levine, B. C. Tilley, J. C. Grotta, M. Lu, M. Frankel, E. C. Haley Jr, T. G. Brott, J. P. Broderick, S. Horowitz, et al. Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke JAMA, December 12, 2001; 286(22): 2830 - 2838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. W. Pexman, P. A. Barber, M. D. Hill, R. J. Sevick, A. M. Demchuk, M. E. Hudon, W. Y. Hu, and A. M. Buchan Use of the Alberta Stroke Program Early CT Score (ASPECTS) for Assessing CT Scans in Patients with Acute Stroke AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1534 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Maldjian, J. Chalela, S. E. Kasner, D. Liebeskind, and J. A. Detre Automated CT Segmentation and Analysis for Acute Middle Cerebral Artery Stroke AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1050 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. von Kummer, H. Bourquain, S. Bastianello, L. Bozzao, C. Manelfe, D. Meier, and W. Hacke Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT Radiology, April 1, 2001; 219(1): 95 - 100. [Abstract] [Full Text]
|
|
|
|
|
|
J. O. Karonen, Y. Liu, R. L. Vanninen, L. Østergaard, P. L. Kaarina Partanen, P. A. Vainio, E. J. Vanninen, J. Nuutinen, R. Roivainen, S. Soimakallio, et al. Combined Perfusion- and Diffusion-weighted MR Imaging in Acute Ischemic Stroke during the 1st Week: A Longitudinal Study Radiology, December 1, 2000; 217(3): 886 - 894. [Abstract] [Full Text]
|
|
|
|
|
|
D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Relationship Between Apparent Diffusion Coefficient and Subsequent Hemorrhagic Transformation Following Acute Ischemic Stroke Stroke, October 1, 2000; 31(10): 2378 - 2384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. von Kummer, N. J. Beauchamp Jr, P. B. Barker, P. Y. Wang, and P. C. M. vanZijl CT of Acute Cerebral Ischemia Dr Beauchamp and colleagues respond: Radiology, August 1, 2000; 216(2): 611 - 613. [Full Text]
|
|
|
|
|
|
M. A. Kalafut, D. L. Schriger, J. L. Saver, and S. Starkman Detection of Early CT Signs of >1/3 Middle Cerebral Artery Infarctions : Interrater Reliability and Sensitivity of CT Interpretation by Physicians Involved in Acute Stroke Care Stroke, July 1, 2000; 31(7): 1667 - 1671. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Lansberg, G. W. Albers, C. Beaulieu, and M. P. Marks Comparison of diffusion-weighted MRI and CT in acute stroke Neurology, April 25, 2000; 54(8): 1557 - 1561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Reichenbach, J. Röther, L. Jonetz-Mentzel, M. Herzau, A. Fiala, C. Weiller, and W. A. Kaiser Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1842 - 1850. [Abstract] [Full Text]
|
|
|
|
|
|
P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, T. Li, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis Identification of Major Ischemic Change : Diffusion-Weighted Imaging Versus Computed Tomography Stroke, October 1, 1999; 30(10): 2059 - 2065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Grotta, D. Chiu, M. Lu, S. Patel, S. R. Levine, B. C. Tilley, T. G. Brott, E. C. Haley Jr, P. D. Lyden, R. Kothari, et al. Agreement and Variability in the Interpretation of Early CT Changes in Stroke Patients Qualifying for Intravenous rtPA Therapy Stroke, August 1, 1999; 30(8): 1528 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Early Ischemic Stroke Changes Difficult to Interpret on CT Journal Watch Emergency Medicine, April 1, 1999; 1999(401): 22 - 22. [Full Text]
|
|