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(Stroke. 2000;31:133.)
© 2000 American Heart Association, Inc.

Original Contributions

Early X-Ray Hypoattenuation of Brain Parenchyma Indicates Extended Critical Hypoperfusion in Acute Stroke

M. Grond, MD; R. von Kummer, MD; J. Sobesky, MD; S. Schmülling, MD; J. Rudolf, MD; K. Terstegge, MD W.-D. Heiss, MD

From the Klinik und Poliklinik für Neurologie (M.G., S.S., J.R., W.-D.H.) and the Institut und Poliklinik für radiologische Diagnostik (K.T.) der Universität zu Köln; the Abteilung für Neuroradiologie der Technischen Universität Dresden (R.v.K.); and the Max-Planck-Institut für neurologische Forschung, Köln (J.S., W.-D.H.), Germany.

Correspondence to Dr Martin Grond, Klinik und Poliklinik für Neurologie der Universität zu Köln, Joseph-Stelzmann-Straße 9, D-50924 Köln, Germany. E-mail martin.grond{at}pet.mpin-koeln.mpg.de

Background and Purpose—The presence of early x-ray hypoattenuation is an important selection criterion for thrombolytic therapy. However, knowledge about the pathophysiological constellation reflected by this hypoattenuation is lacking. Our objective was to study the relationship between the presence of early CT hypoattenuation and the volumes of critical cortical hypoperfusion.

Methods—In 32 patients with acute ischemic stroke, CT was performed 20 to 170 minutes (mean, 94 minutes) after symptom onset, and [¹⁵O]H₂O-PET 20 to 120 minutes (mean, 67 minutes) later. CTs were scrutinized for the presence of hypoattenuation. On the PET scans, the volumes of critical cortical hypoperfusion were assessed.

Results—CT hypoattenuation was present in 18 patients (56%), all of whom had critical cortical hypoperfusion and developed infarction. Of the 14 patients with normal CTs, critical hypoperfusion was found in 6, and 7 developed infarction. The mean volumes of critically hypoperfused tissue differed significantly (P=0.0001, Wilcoxon test) between the CT normal (mean 13.9 cm³, range 0 to 71 cm³) and the CT abnormal (mean 116.3 cm³, range 4 to 389 cm³) groups.

Conclusions—Early presence of hypoattenuation is indicative of extended volumes of critically hypoperfused cortical tissue. The extent of hypoperfusion may exceed that of hypoattenuation, and some of that tissue might still be salvageable.

Key Words: stroke, acute • computed tomography • positron emission tomography

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