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(Stroke. 2005;36:2601.)
© 2005 American Heart Association, Inc.

Original Contributions

Presence of Early Ischemic Changes on Computed Tomography Depends on Severity and the Duration of Hypoperfusion

A Single Photon Emission-Computed Tomographic Study

From the Department of Neurology (T.H., M.U.), Graduate School of Medical Sciences, Kumamoto University; Department of Neurology (T.Y., Y.I.), Stroke Center, Saiseikai Kumamoto Hospital; Department of Neurology (Y.H.), Kumamoto City Hospital, Kumamoto, Japan.

Correspondence to Teruyuki Hirano, MD, Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan. E-mail terry{at}kaiju.medic.kumamoto-u.ac.jp

Background and Purpose— To evaluate the clinical significance of early ischemic change (EIC) on computed tomography (CT), pertinent factors that contribute to the appearance of EIC.

Methods— Both CT and technetium-99m hexamethylpropylene amine oxime were performed on a total of 53 patients (34 men, 19 women, mean 69.7 years old) with acute embolic stroke within 6 hours of onset. Patients were excluded if they showed definite clinical recovery or were administered thrombolytic agents. EIC was evaluated using Alberta Stroke Program Early CT Score (ASPECTS). Residual cerebral blood flow (CBF) was determined on SPECT. Variables that were considered pertinent were patients’ age, gender, neurological severity, symptom duration, and residual CBF. Using significant pertinent factors for EIC, separate analyses of brain swelling without hypoattenuation and parenchymal hypoattenuation were performed.

Results— Patients with EIC (n=37) showed severe neurological deficits, a longer duration and severe hypoperfusion. A positive correlation was observed between ASPECTS and residual CBF (P=0.002; Kruskal-Wallis test). A logistic-regression analysis revealed that both symptom duration (r=0.024, P=0.006) and severity of hypoperfusion (r= –12.167, P=0.006) are independent factors related to EIC. Symptom duration and residual CBF were significantly different among patients with parenchymal hypoattenuation (n=32), brain swelling without hypoattenuation (n=5), and no EIC (P=0.018 and P=0.001, respectively; one-way ANOVA).

Conclusions— The presence of EIC is determined by the duration and the degree of hypoperfusion. This finding supports the hypothesis that tissue damage may be evaluated by a combination of onset time and the presence of EIC.

Key Words: ischemia • ischemic stroke • thrombolytic therapy • tomography, x-ray computed • tomography, emission computed

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