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Significance of early CT signs in acute stroke. A CT scan-diffusion MRI study
Assia Jaillard1, Marc Hommel, Alison E Baird
1Department of Clinical and Biological Neurosciences, Stroke Unit University Hospital, Grenoble, France. Assia.Jaillard@ujf-grenoble.fr
Objective:
To study the pathophysiology of early CT signs.
Background:
Early CT signs, due to an increase in tissue water content, are commonly attributed to cytotoxic edema and development of irreversible injury. This may have important implications for thrombolysis.
Methods:
In patients with acute ischemic stroke in the middle cerebral artery territory, the areas of early CT signs and diffusion weighted imaging (DWI) hypersignal were independently assessed and drawn on a standardized atlas. Then, patients were classified into three groups (early CT signs larger than, similar to or smaller than DWI hypersignal) and compared with perfusion weighted imaging (PWI).
Results:
Of 16 patients, CT scanning was performed with a median time of 3 h after onset and early CT scan signs were recorded in 10/16 patients (62.5%). DWI signal hyperintensity was present in 15/16 (94%) patients. In 7/16 (43%) patients, the area with early CT scan signs was larger than the DWI lesion ('CT-larger group'). Only in 2/16 (12%) patients were the areas matching ('matching group'). In 7/16 (43%) the DWI lesion was larger than the early CT scan signs area ('DWI-larger group'). When compared with PWI, the areas of early CT signs were larger than DWI hypersignal and were matching with PWI abnormalities (rMTT) in 2 cases, suggesting that they may represent a reversible process.
Conclusions:
Early CT signs might have a potential dual fate: infarction or reversibility. Other techniques of recognizing reversible ischemic damage, such as DWI-PWI, are needed to improve acute stroke diagnosis and management.