This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (41)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Radiologic Imaging  • Cerebrovascular Disease  • Stroke  • Magnetic Resonance Imaging  • Alert me on articles by topic

Joachim Röther, MD; Lars Jonetz-Mentzel, MD; Anke Fiala, MS; Jürgen R. Reichenbach, PhD; Michael Herzau, MD; Werner A. Kaiser, MD; Cornelius Weiller, MD

Arch Neurol. 2000;57:1161-1166.

Background  Stroke management would benefit from a broadly available imaging tool that detects perfusion deficits in patients with acute stroke.

Objective  To determine the role of dynamic, single-slice computed tomographic (CT) perfusion imaging (CTP) in the assessment of acute middle cerebral artery stroke.

Design and Patients  Imaging with CTP and CT within the first 6 hours of symptom onset and before the start of treatment in a consecutive clinical series of 22 patients (mean age, 68.3 years; 14 women; studied within 143 ± 96 minutes of stroke onset).

Setting  A stroke unit in a university hospital.

Main Outcome Measures  Area of the perfusion deficit (nAP₀) from time-to-peak maps, hemispheric lesion area from follow-up CT (HLA_F), final infarct volume, and stroke recovery (National Institutes of Health Stroke Scale scores).

Results  Eighteen patients had perfusion deficits in the middle cerebral artery territory and corresponding hypoattenuation in follow-up CT. Three patients with normal CTP findings showed lacunar infarctions or normal findings on follow-up CT. In 1 patient, CTP did not reveal a territorial deficit above the imaging slice. The overall sensitivity and specificity of CTP for the detection of perfusion deficits in patients with proven territorial infarction (n = 18) on follow-up CT were 95% and 100%, respectively. The nAP₀ was significantly correlated with the National Institutes of Health Stroke Scale score at admission (P<.003) and the HLA_F (P<.001). Different stroke patterns were identified in patients with follow-up CTP (n = 10): (1) initial perfusion deficit and partial nutritional reperfusion (nAP₀>HLA_F; n = 6), (2) initial perfusion deficit and nonnutritional reperfusion (nAP₀HLA_F; n = 2), and (3) initial perfusion deficit without reperfusion (nAP₀HLA_F; n = 2).

Conclusions  Computed tomographic perfusion imaging detects major perfusion deficits in the middle cerebral artery territory. Because CTP is broadly available, it may play a role in acute stroke management.

From the Department of Neurology (Drs Röther and Weiller and Ms Fiala) and the Institute of Diagnostic and Interventional Radiology (Drs Jonetz-Mentzel, Reichenbach, Herzau, and Kaiser), Friedrich-Schiller-University Jena, Jena, Germany.

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2000;57(8):1241-1242.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Measuring Elevated Microvascular Permeability and Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Using First-Pass Dynamic Perfusion CT Imaging
Lin et al.
Am. J. Neuroradiol. 2007;28:1292-1298.
ABSTRACT | FULL TEXT  

CT Angiography and Perfusion CT in Cerebral Vasospasm after Subarachnoid Hemorrhage
Binaghi et al.
Am. J. Neuroradiol. 2007;28:750-758.
ABSTRACT | FULL TEXT  

Imaging-guided acute ischemic stroke therapy: From "time is brain" to "physiology is brain".
Gonzalez
Am. J. Neuroradiol. 2006;27:728-735.
ABSTRACT | FULL TEXT  

Perfusion CT helps decision making for thrombolysis when there is no clear time of onset.
Hellier et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:417-419.
ABSTRACT | FULL TEXT  

Visual evaluation of perfusion computed tomography in acute stroke accurately estimates infarct volume and tissue viability
Muir et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:334-339.
ABSTRACT | FULL TEXT  

Accuracy of Dynamic Perfusion CT with Deconvolution in Detecting Acute Hemispheric Stroke
Wintermark et al.
Am. J. Neuroradiol. 2005;26:104-112.
ABSTRACT | FULL TEXT  

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
Schramm et al.
Stroke 2004;35:1652-1658.
ABSTRACT | FULL TEXT  

User-defined Vascular Input Function Curves: Influence on Mean Perfusion Parameter Values and Signal-to-Noise Ratio
Kealey et al.
Radiology 2004;231:587-593.
ABSTRACT | FULL TEXT  

Bedside assessment of cerebral perfusion reductions in patients with acute ischaemic stroke by near-infrared spectroscopy and indocyanine green
Terborg et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:38-42.
ABSTRACT | FULL TEXT  

Correlation of Early Dynamic CT Perfusion Imaging with Whole-Brain MR Diffusion and Perfusion Imaging in Acute Hemispheric Stroke
Eastwood et al.
Am. J. Neuroradiol. 2003;24:1869-1875.
ABSTRACT | FULL TEXT  

Sensitivity and Interrater Agreement of CT and Diffusion-Weighted MR Imaging in Hyperacute Stroke
Saur et al.
Am. J. Neuroradiol. 2003;24:878-885.
ABSTRACT | FULL TEXT  

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
Latchaw et al.
Stroke 2003;34:1084-1104.
FULL TEXT  

Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status
Schellinger et al.
Stroke 2003;34:575-583.
ABSTRACT | FULL TEXT  

Perfusion CT with Iodinated Contrast Material
Eastwood et al.
Am. J. Roentgenol. 2003;180:3-12.
FULL TEXT  

MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: Novel Diagnostic Approach for the Prediction of Infarction Size and Clinical Outcome
Nabavi et al.
Stroke 2002;33:2819-2826.
ABSTRACT | FULL TEXT  

Perfusion CT Scans
von Kummer et al.
Am. J. Neuroradiol. 2002;23:343-344.
FULL TEXT  

Multisection Dynamic CT Perfusion for Acute Cerebral Ischemia: The "Toggling-table" Technique
Roberts et al.
Am. J. Neuroradiol. 2001;22:1077-1080.
ABSTRACT | FULL TEXT  

CT Perfusion: Two Publications, Same Patients, Different Results
von Kummer et al.
Arch Neurol 2001;58:835-837.
FULL TEXT  

Perfusion Mapping Using Computed Tomography Allows Accurate Prediction of Cerebral Infarction in Experimental Brain Ischemia Editorial Comment
Nabavi et al.
Stroke 2001;32:175-183.
ABSTRACT | FULL TEXT  

CT Perfusion Scanning with Deconvolution Analysis: Pilot Study in Patients with Acute Middle Cerebral Artery Stroke
Eastwood et al.
Radiology 2002;222:227-236.
ABSTRACT | FULL TEXT