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Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion
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.
Journal of Computer Assisted Tomography
|January 13, 2004
Summary
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.