Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps
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Published on: September 25, 2019
Jae Wook Ryoo1, Dong Gyu Na, Sam Soo Kim
1Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Objective:
The purpose of this study was to compare the incidence of large hypoperfusion (greater than two-thirds of MCA territory) on computed tomography (CT) perfusion maps between hyperacute middle cerebral artery (MCA) stroke patients without or with malignant cerebral edema.
Methods:
Twenty-seven patients diagnosed with a hyperacute MCA stroke who had an initial National Institutes of Health Stroke Scale (NIHSS) score greater than 10 were included. Multiphasic perfusion CT was performed within 6 hours of symptom onset. Patients were divided into 2 groups: the malignant group (n = 11), composed of patients who died within 7 days, and the nonmalignant group, which included all other patients (n = 16). Unenhanced CT and CT perfusion maps were assessed and compared between the 2 groups with special emphasis on examining the CT findings, including hyperdense MCA sign, large (greater than two-thirds) hypoattenuation and hypoperfusion in the MCA territory, and hypoattenuation in the basal ganglia and other vascular territories.
Results:
The incidence of large hypoattenuation (greater than two-thirds of MCA territory) on unenhanced CT and large hypoperfusion on CT perfusion maps differed significantly between the 2 groups (P < 0.05). Large hypoperfusion on the CT total perfusion map was most accurate (93%) among various CT findings for the prediction of malignant MCA infarction with high sensitivity (91%), specificity (94%), and positive predictive value (91%).
Conclusions:
The incidence of large hypoperfusion on a CT perfusion map was higher in the malignant group than the nonmalignant group. CT perfusion maps may provide added information about cerebral perfusion and could be a useful predictor of malignant MCA infarction.
Insights
Large hypoperfusion on computed tomography (CT) perfusion maps is more common in malignant middle cerebral artery (MCA) stroke patients. CT perfusion maps can help predict malignant MCA infarction.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hyperacute stroke in the middle cerebral artery (MCA) territory can lead to malignant cerebral edema.
- Predicting malignant outcomes in stroke patients is crucial for timely intervention.
Purpose of the Study:
- To compare the incidence of large hypoperfusion on CT perfusion maps in hyperacute MCA stroke patients with and without malignant cerebral edema.
- To evaluate CT perfusion maps as a predictor of malignant MCA infarction.
Main Methods:
- Twenty-seven hyperacute MCA stroke patients (NIHSS > 10) within 6 hours of onset were analyzed.
- Patients were categorized into malignant (died within 7 days, n=11) and nonmalignant (n=16) groups.
- CT perfusion maps and unenhanced CT were assessed for hypoperfusion, hypoattenuation, and other stroke imaging markers.
Main Results:
- A significant difference in large hypoperfusion (greater than two-thirds MCA territory) was observed between the groups (P < 0.05).
- Large hypoperfusion on CT perfusion maps demonstrated high accuracy (93%) in predicting malignant MCA infarction, with high sensitivity (91%) and specificity (94%).
Conclusions:
- The incidence of large hypoperfusion on CT perfusion maps was significantly higher in patients who developed malignant cerebral edema.
- CT perfusion imaging offers valuable insights into cerebral perfusion and serves as a potential predictor for malignant MCA stroke.
