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Functional image of dynamic computed tomography in diagnostic and prognostic evaluation of ischemic stroke within the
T Toriyama1, Y Tanizaki, K Hongo
1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Insights
Dynamic computed tomography functional imaging accurately detects arterial trunk occlusion in acute ischemic stroke. This method predicts infarction volume and clinical outcomes, aiding treatment decisions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Early diagnosis of acute ischemic stroke is crucial for effective management.
- Computed tomography (CT) is a primary diagnostic tool, but identifying ischemic changes before hypodensity appears is challenging.
Purpose of the Study:
- To evaluate the diagnostic and prognostic utility of functional imaging from dynamic computed tomography (dCT) in acute ischemic stroke.
- To assess the correlation between dCT findings and arterial occlusion, infarct volume, and clinical outcomes.
Main Methods:
- Forty-seven patients with ischemic stroke within 6 hours of symptom onset underwent dCT.
- Functional images from dCT were analyzed and categorized.
- Findings were compared with angiography, follow-up CT, and clinical outcomes.
Main Results:
- Functional dCT images were classified into cortical (29 cases), noncortical (7 cases), and normal (11 cases) types.
- Cortical type demonstrated high sensitivity (100%), specificity (95%), and accuracy (98%) for detecting arterial trunk occlusion.
- Infarct volume correlated strongly with prolonged time-to-peak and corrected mean transit time areas on dCT. Cortical type was linked to unfavorable clinical outcomes.
Conclusions:
- Dynamic CT functional imaging effectively predicts arterial trunk occlusion, infarct volume, and clinical outcomes in acute ischemic stroke.
- This technique is valuable for guiding angiography, therapy selection, and evaluating recanalization treatment effectiveness.
Background And Purpose:
It is important to make a diagnosis before a low-density area appears on computed tomography for appropriate management of acute ischemic stroke. We report the diagnostic and prognostic usefulness of functional image of dynamic computed tomography for acute ischemic stroke.
Methods:
Forty-seven patients with ischemic strokes within 6 hours of ictus underwent dynamic computed tomography in which functional images were obtained. These findings were compared with angiographic findings, follow-up computed tomography, and clinical outcome.
Results:
The functional images were categorized into three groups: (1) cortical type: abnormalities on time to peak image and/or corrected mean transit time image involving mainly cortical structures (29 cases); (2) noncortical type: abnormalities on either or both images limited to noncortical structures (7 cases); and (3) normal type: no abnormalities on both images (11 cases). Cortical type as a diagnostic test for arterial trunk occlusion had a good sensitivity (100%), specificity (95%), and accuracy (98%). Infarction volume on follow-up computed tomography correlated with extension of prolonged time-to-peak area (r = .80, P < .01) and that of prolonged corrected mean transit time area (r = .81, P < .01). Cortical type was associated with significantly unfavorable outcome (P < .01).
Conclusions:
Functional image of dynamic computed tomography findings predicted arterial trunk occlusion, infarction volume, and clinical outcome. Therefore, this technique would be useful not only for indicating definitive angiography and subsequent therapy but for evaluating the effectiveness of surgical or medical recanalization.