Stroke. 2001;32:2021-2028
doi: 10.1161/hs0901.095680
doi: 10.1161/hs0901.095680
(Stroke. 2001;32:2021.)
© 2001 American Heart Association, Inc.
Original Contributions |
Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:
Prediction of Final Infarct Volume and Clinical Outcome
From the Departments of Radiology M.H.L., J.F., S.T.H., C.P., G.J.H., R.B., G.J.H., R.G.G.), Neurology (A.Z.S., F.S.B., W.J.K., L.S.), and Medicine (Y.C.), Massachusetts General Hospital, Harvard Medical School, Boston, and National Institute of Neurological Disorders and Stroke (M.A.E.), National Institutes of Health, Bethesda, Md.
Correspondence to Michael H. Lev, MD, Massachusetts General Hospital, Department of Radiology-GRB285, PO Box 9657, Boston, MA 02114-9657. E-mail mlev{at}partners.org
Background and Purpose—— The goal of this study was to evaluate the utility of perfusion-weighted CT (PWCT) in predicting final infarct volume and clinical outcome in patients with acute middle cerebral artery (MCA) stroke.
Methods—— Twenty-two consecutive patients with MCA stem occlusion who underwent intra-arterial thrombolysis within 6 hours of stroke onset had noncontrast CT and CT angiography with whole-brain PWCT imaging before treatment. Infarct volumes were computed from the initial PWCT and follow-up scans; clinical outcome was measured with the modified Rankin scale.
Results—— Initial PWCT lesion volumes correlated significantly with final infarct volume (P=0.0002) and clinical outcome (P=0.01). For the 10 patients with complete recanalization, the relationship between initial and final lesion volume was especially strong (R2=0.94, P<0.0001, slope of regression line=0.92). For those without complete recanalization, there was progression of lesion volume on follow-up imaging (R2=0.50, P=0.01, slope of regression line=1.61). All patients with either initial PWCT lesion volumes >100 mL or no recanalization had poor outcomes (Rankin scores, 4 to 6). Mean admission NIH Stroke Scale scores and mean lesion volumes in the poor outcome group were significantly different compared with the good or fair outcome (Rankin scores, 0 to 3) group (21±4 versus 17±5, P=0.05, and 106±79 versus 29±37 mL, P=0.01). Patients with initial volumes <100 mL and partial or complete recanalization all had good (Rankin scores, 0 to 2) or fair (Rankin score, 3) outcomes.
Conclusions—— Lesion volumes on admission PWCT images approximate final infarct volume for patients with early complete recanalization of MCA stem occlusion. For those without complete recanalization, there is subsequent enlargement of lesion volume on follow-up. Initial PWCT lesion volumes also have predictive value; volumes >100 mL are associated with a poor clinical outcome. In these highly selected patients, initial PWCT lesion volume was a stronger predictor of clinical outcome than was initial NIH Stroke Scale score.
Editorial Comment
Prediction of Final Infarct Volume and Clinical Outcome
This article has been cited by other articles:
 |
|
 |
|
  E. M. de Lucas, E. Sanchez, A. Gutierrez, A. G. Mandly, E. Ruiz, A. F. Florez, J. Izquierdo, J. Arnaiz, T. Piedra, N. Valle, et al. CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists RadioGraphics, October 1, 2008; 28(6): 1673 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.M. Provenzale, K. Shah, U. Patel, and D.C. McCrory Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1476 - 1482. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.S. Rosenthal, L.H. Schwamm, L. Roccatagliata, S.B. Coutts, A.M. Demchuk, P.W. Schaefer, R.G. Gonzalez, M.D. Hill, E.F. Halpern, and M.H. Lev Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1471 - 1475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Puetz, P.N. Sylaja, S. B. Coutts, M. D. Hill, I. Dzialowski, P. Mueller, U. Becker, G. Urban, C. O'Reilly, P. A. Barber, et al. Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion Stroke, September 1, 2008; 39(9): 2485 - 2490. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.M. Silvennoinen, L.M. Hamberg, P.J. Lindsberg, L. Valanne, and G.J. Hunter CT Perfusion Identifies Increased Salvage of Tissue in Patients Receiving Intravenous Recombinant Tissue Plasminogen Activator within 3 Hours of Stroke Onset AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1118 - 1123. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein Acute Ischemic Stroke Treatment in 2007 Circulation, September 25, 2007; 116(13): 1504 - 1514. [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. S. Camargo, K. L. Furie, A. B. Singhal, L. Roccatagliata, M. E. Cunnane, E. F. Halpern, G. J. Harris, W. S. Smith, R. G. Gonzalez, W. J. Koroshetz, et al. Acute Brain Infarct: Detection and Delineation with CT Angiographic Source Images versus Nonenhanced CT Scans Radiology, August 1, 2007; 244(2): 541 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Banks and C. A. Marotta Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis Stroke, March 1, 2007; 38(3): 1091 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Meschia, L. D. Case, B. B. Worrall, R. D. Brown Jr, T. G. Brott, M. Frankel, S. Silliman, S. S. Rich, and for the Ischemic Stroke Genetics Study Group Family history of stroke and severity of neurologic deficit after stroke Neurology, October 24, 2006; 67(8): 1396 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.D. Murphy, A.J. Fox, D.H. Lee, D.J. Sahlas, S.E. Black, M.J. Hogan, S.B. Coutts, A.M. Demchuk, M. Goyal, R.I. Aviv, et al. Identification of Penumbra and Infarct in Acute Ischemic Stroke Using Computed Tomography Perfusion-Derived Blood Flow and Blood Volume Measurements Stroke, July 1, 2006; 37(7): 1771 - 1777. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Thomas, L. H. Schwamm, and M. H. Lev Case records of the Massachusetts General Hospital. Case 16-2006. A 72-year-old woman admitted to the emergency department because of a sudden change in mental status. N. Engl. J. Med., May 25, 2006; 354(21): 2263 - 2271. [Full Text] [PDF]
|
|
|
|
|
|
A. Srinivasan, M. Goyal, P. Stys, M. Sharma, and C. Lum Microcatheter navigation and thrombolysis in acute symptomatic cervical internal carotid occlusion. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 774 - 779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.W. Schaefer, L. Roccatagliata, C. Ledezma, B. Hoh, L.H. Schwamm, W. Koroshetz, R.G. Gonzalez, and M.H. Lev First-Pass Quantitative CT Perfusion Identifies Thresholds for Salvageable Penumbra in Acute Stroke Patients Treated with Intra-arterial Therapy AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 20 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Schwamm, E. S. Rosenthal, C. J. Swap, J. Rosand, G. Rordorf, F. S. Buonanno, M. G. Vangel, W. J. Koroshetz, and M. H. Lev Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1798 - 1803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Sims, G. Rordorf, E. E. Smith, W. J. Koroshetz, M. H. Lev, F. Buonanno, and L. H. Schwamm Arterial Occlusion Revealed by CT Angiography Predicts NIH Stroke Score and Acute Outcomes after IV tPA Treatment AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 246 - 251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Hjort, K. Butcher, S.M. Davis, C.S. Kidwell, on behalf of the UCLA Thrombolysis Investigators, W.J. Koroshetz, J. Rother, P.D. Schellinger, S. Warach, and L. Ostergaard Magnetic Resonance Imaging Criteria for Thrombolysis in Acute Cerebral Infarct Stroke, February 1, 2005; 36(2): 388 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wintermark, N. J. Fischbein, W. S. Smith, N. U. Ko, M. Quist, and W. P. Dillon Accuracy of Dynamic Perfusion CT with Deconvolution in Detecting Acute Hemispheric Stroke AJNR Am. J. Neuroradiol., January 1, 2005; 26(1): 104 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Coutts, M. H. Lev, M. Eliasziw, L. Roccatagliata, M. D. Hill, L. H. Schwamm, J.H. W. Pexman, W. J. Koroshetz, M. E. Hudon, A. M. Buchan, et al. ASPECTS on CTA Source Images Versus Unenhanced CT: Added Value in Predicting Final Infarct Extent and Clinical Outcome Stroke, November 1, 2004; 35(11): 2472 - 2476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Kloska, D. G. Nabavi, C. Gaus, E.-M. Nam, E. Klotz, E. B. Ringelstein, and W. Heindel Acute Stroke Assessment with CT: Do We Need Multimodal Evaluation? Radiology, October 1, 2004; 233(1): 79 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wintermark, G. van Melle, P. Schnyder, J.-P. Revelly, F. Porchet, L. Regli, R. Meuli, P. Maeder, and R. Chiolero Admission Perfusion CT: Prognostic Value in Patients with Severe Head Trauma Radiology, July 1, 2004; 232(1): 211 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Schramm, P. D. Schellinger, E. Klotz, K. Kallenberg, J. B. Fiebach, S. Kulkens, S. Heiland, M. Knauth, and K. Sartor Comparison of Perfusion Computed Tomography and Computed Tomography Angiography Source Images With Perfusion-Weighted Imaging and Diffusion-Weighted Imaging in Patients With Acute Stroke of Less Than 6 Hours' Duration Stroke, July 1, 2004; 35(7): 1652 - 1658. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Husain Clinical and radiological predictors of recanalisation: time to define a rapid scoring system J. Neurol. Neurosurg. Psychiatry, June 1, 2004; 75(6): 811 - 812. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Wintermark, D. Lepori, J. Cotting, E. Roulet, G. van Melle, R. Meuli, P. Maeder, L. Regli, F. R. Verdun, T. Deonna, et al. Brain Perfusion in Children: Evolution With Age Assessed by Quantitative Perfusion Computed Tomography Pediatrics, June 1, 2004; 113(6): 1642 - 1652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wintermark, W. S. Smith, N. U. Ko, M. Quist, P. Schnyder, and W. P. Dillon Dynamic Perfusion CT: Optimizing the Temporal Resolution and Contrast Volume for Calculation of Perfusion CT Parameters in Stroke Patients AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 720 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H S Markus Cerebral perfusion and stroke J. Neurol. Neurosurg. Psychiatry, March 1, 2004; 75(3): 353 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Carter, J. D. Rabinov, R. Pfannl, and L. H. Schwamm Case 5-2004 - A 57-Year-Old Man with Slurred Speech and Left Hemiparesis N. Engl. J. Med., February 12, 2004; 350(7): 707 - 716. [Full Text] [PDF]
|
|
|
|
|
|
M. Kaste Reborn Workhorse, CT, Pulls the Wagon Toward Thrombolysis Beyond 3 Hours Stroke, February 1, 2004; 35(2): 357 - 359. [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein Blood Pressure Management in Patients With Acute Ischemic Stroke Hypertension, February 1, 2004; 43(2): 137 - 141. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Burdette Is CT Perfusion Ready for Prime Time? AJNR Am. J. Neuroradiol., January 1, 2004; 25(1): 3 - 4. [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]
|
|
|
|
|
|
J. D. Eastwood, M. H. Lev, M. Wintermark, C. Fitzek, D. P. Barboriak, D. M. Delong, T.-Y. Lee, T. Azhari, M. Herzau, V. R. Chilukuri, et al. Correlation of Early Dynamic CT Perfusion Imaging with Whole-Brain MR Diffusion and Perfusion Imaging in Acute Hemispheric Stroke AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1869 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Hill, H. A. Rowley, F. Adler, M. Eliasziw, A. Furlan, R. T. Higashida, L. R. Wechsler, H. C. Roberts, W. P. Dillon, N. J. Fischbein, et al. Selection of Acute Ischemic Stroke Patients for Intra-Arterial Thrombolysis With Pro-Urokinase by Using ASPECTS Stroke, August 1, 2003; 34(8): 1925 - 1931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. F. Tomandl, E. Klotz, R. Handschu, B. Stemper, F. Reinhardt, W. J. Huk, K.E. Eberhardt, and S. Fateh-Moghadam Comprehensive Imaging of Ischemic Stroke with Multisection CT RadioGraphics, May 1, 2003; 23(3): 565 - 592. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
K. Kudo, S. Terae, C. Katoh, M. Oka, T. Shiga, N. Tamaki, and K. Miyasaka Quantitative Cerebral Blood Flow Measurement with Dynamic Perfusion CT Using the Vascular-Pixel Elimination Method: Comparison with H215O Positron Emission Tomography AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 419 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Eastwood, M. H. Lev, and J. M. Provenzale Perfusion CT with Iodinated Contrast Material Am. J. Roentgenol., January 1, 2003; 180(1): 3 - 12. [Full Text] [PDF]
|
|
|
|
|
|
M. H. Lev, W. J. Koroshetz, L. H. Schwamm, R. G. Gonzalez, and T. Tatlisumak CT or MRI for Imaging Patients with Acute Stroke: Visualization of "Tissue at Risk"? Stroke, December 1, 2002; 33(12): 2736 - 2737. [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]
|
|
|
|
|
|
V. S. Caviness, N. Makris, E. Montinaro, N. T. Sahin, J. F. Bates, L. Schwamm, D. Caplan, and D. N. Kennedy Anatomy of Stroke, Part I: An MRI-Based Topographic and Volumetric System of Analysis Stroke, November 1, 2002; 33(11): 2549 - 2556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Schramm, P. D. Schellinger, J. B. Fiebach, S. Heiland, O. Jansen, M. Knauth, W. Hacke, and K. Sartor Comparison of CT and CT Angiography Source Images With Diffusion-Weighted Imaging in Patients With Acute Stroke Within 6 Hours After Onset Stroke, October 1, 2002; 33(10): 2426 - 2432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, J. I. Suarez, C. Santillan, J. L. Sunshine, R. W. Tarr, V. H. Paras, W. R. Selman, D. M.D. Landis, and D. D. Tong Response to Intra-Arterial and Combined Intravenous and Intra-Arterial Thrombolytic Therapy in Patients With Distal Internal Carotid Artery Occlusion * Editorial Comment Stroke, July 1, 2002; 33(7): 1821 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Lev CT/MR Perfusion Imaging and Alphabet Soup: An Appeal for Standardized Nomenclature AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 746 - 747. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Ezzeddine, M. H. Lev, C. T. McDonald, G. Rordorf, J. Oliveira-Filho, F. G. Aksoy, J. Farkas, A. Z. Segal, L. H. Schwamm, R. G. Gonzalez, et al. CT Angiography With Whole Brain Perfused Blood Volume Imaging: Added Clinical Value in the Assessment of Acute Stroke Stroke, April 1, 2002; 33(4): 959 - 966. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Can PWCT in Acute Stroke Predict Outcome After Thrombolytic Therapy? Journal Watch Neurology, November 21, 2001; 2001(1121): 3 - 3. [Full Text]
|
|