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Limited versus Whole-Brain Perfusion for the Indication of Thrombolysis in the Extended Time Window of Acute Cerebral Ischemia.
- Source :
- Journal of Stroke & Cerebrovascular Diseases; Nov2015, Vol. 24 Issue 11, p2491-2496, 6p
- Publication Year :
- 2015
-
Abstract
- <bold>Background: </bold>Perfusion computed tomography (PCT) has emerged as alternative to magnetic resonance imaging (MRI) for assessment of patients clinically qualifying for off-label thrombolysis within 4.5 to 9 hours after onset of ischemic stroke. However, disadvantage of PCT is its often limited anatomic coverage with only 2 or 3 slices when using a 4- to 64-section scanner. Our purpose was therefore to evaluate the value of 2- and 3-slice perfusion compared to whole-brain perfusion.<bold>Methods: </bold>One hundred twenty-five patients undergoing MRI beyond 4.5 hours after symptom onset with supratentorial perfusion deficit were selected retrospectively. Accordingly to PCT slice positioning, 2 or 3 slices of the whole-brain perfusion weighted imaging data set were depicted. Volumes of infarct (using cerebral blood volume) and penumbra (using time-to-peak and cerebral blood volume) were calculated, and results were compared with 2- and 3-slice-derived volumes, respectively.<bold>Results: </bold>Whole-brain imaging revealed a mismatch of more than 20% in 68.8% of patients (defined as 100%). Two-slice imaging detected a perfusion deficit in 72% and a mismatch in 48.8% (sensitivity = 70.9%). Three-slice imaging detected a perfusion deficit in 76% and a mismatch in 50.4% (sensitivity = 73.3%). Although there was no significant difference between 2- and 3-slice imaging (P > .23), both techniques revealed significantly less patients with mismatch compared to whole-brain coverage (P < .01).<bold>Conclusions: </bold>Two- and 3-slice imaging like obtained with PCT on most installed CT systems to assess perfusion deficits with subsequent mismatch calculation in acute stroke outside the 4.5-hour time window is significantly inferior to whole-brain coverage and, hence, has to be considered as a less-than-ideal solution. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10523057
- Volume :
- 24
- Issue :
- 11
- Database :
- Supplemental Index
- Journal :
- Journal of Stroke & Cerebrovascular Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 110577187
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.017