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Published on: May 4, 2015
Defining the extent of irreversible brain ischemia using perfusion computed tomography
Andrew Bivard1, Patrick McElduff, Neil Spratt
1Department of Neurology and Hunter Medical Research Institute, University of Newcastle, Newcastle, N.S.W., Australia.
Cerebrovascular Diseases (Basel, Switzerland)
|December 24, 2010
Summary
A relative cerebral blood flow (CBF) threshold of 45% on perfusion computed tomography (PCT) accurately defines the acute infarct core in stroke patients, improving diagnostic precision.
Area of Science:
- Neuroradiology
- Neuroimaging
- Stroke Imaging
Background:
- Perfusion computed tomography (PCT) is a promising tool for acute stroke assessment.
- The precise accuracy of CT perfusion thresholds for defining the infarct core is not well-established.
Purpose of the Study:
- To evaluate the accuracy of various PCT thresholds in defining the acute infarct core.
- To compare PCT thresholds against MRI-DWI for infarct core delineation.
Main Methods:
- 57 ischemic stroke patients underwent concurrent PCT and MRI-DWI within 3-6 hours of symptom onset.
- Pixel-based ROC analysis was used to compare PCT maps with DWI images.
- The area under the curve (AUC) was calculated for different PCT thresholds.
Main Results:
- A relative cerebral blood flow (CBF) threshold of 45% of the contralateral hemisphere demonstrated the highest accuracy (AUC 0.788) for infarct core definition.
- This 45% CBF threshold was the most consistently accurate and frequently identified threshold across patients.
- Other PCT thresholds, such as cerebral blood volume (CBV) of 2 ml/100 g, were less accurate.
Conclusions:
- Relative CBF thresholds on PCT provide a more accurate method for defining the acute infarct core in ischemic stroke.
- PCT, specifically using CBF thresholds, can reliably delineate infarct core compared to other PCT parameters.
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