NDLI: Limited versus Whole-Brain Perfusion for the Indication of Thrombolysis in the Extended Time Window of Acute Cerebral Ischemia.

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Limited versus Whole-Brain Perfusion for the Indication of Thrombolysis in the Extended Time Window of Acute Cerebral Ischemia.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Breuer, Lorenz Knott, Michael Struffert, Tobias Kloska, Stephan Kurka, Natalia Schwab, Stefan Dörfler, Arnd Köhrmann, Martin Engelhorn, Tobias
Description	Author Affiliation: Breuer L ( Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. Electronic address: lorenz.breuer@uk-erlangen.de.); Knott M ( Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.); Struffert T ( Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.); Kloska S ( Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.); Kurka N ( Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.); Schwab S ( Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.); Dörfler A ( Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.); Köhrmann M ( Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.); Engelhorn T ( Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.)
Abstract	BACKGROUND: Perfusion computed tomography (PCT) has emerged as alternative to magnetic resonance imaging (MRI) for assessment of patients clinically qualifying for off-label thrombolysis within 4.5 to 9 hours after onset of ischemic stroke. However, disadvantage of PCT is its often limited anatomic coverage with only 2 or 3 slices when using a 4- to 64-section scanner. Our purpose was therefore to evaluate the value of 2- and 3-slice perfusion compared to whole-brain perfusion. METHODS: One hundred twenty-five patients undergoing MRI beyond 4.5 hours after symptom onset with supratentorial perfusion deficit were selected retrospectively. Accordingly to PCT slice positioning, 2 or 3 slices of the whole-brain perfusion weighted imaging data set were depicted. Volumes of infarct (using cerebral blood volume) and penumbra (using time-to-peak and cerebral blood volume) were calculated, and results were compared with 2- and 3-slice-derived volumes, respectively. RESULTS: Whole-brain imaging revealed a mismatch of more than 20% in 68.8% of patients (defined as 100%). Two-slice imaging detected a perfusion deficit in 72% and a mismatch in 48.8% (sensitivity = 70.9%). Three-slice imaging detected a perfusion deficit in 76% and a mismatch in 50.4% (sensitivity = 73.3%). Although there was no significant difference between 2- and 3-slice imaging (P > .23), both techniques revealed significantly less patients with mismatch compared to whole-brain coverage (P < .01). CONCLUSIONS: Two- and 3-slice imaging like obtained with PCT on most installed CT systems to assess perfusion deficits with subsequent mismatch calculation in acute stroke outside the 4.5-hour time window is significantly inferior to whole-brain coverage and, hence, has to be considered as a less-than-ideal solution.
File Format	HTM / HTML
ISSN	10523057
Issue Number	11
Volume Number	24
e-ISSN	15328511
Journal	Journal of Stroke and Cerebrovascular Diseases
Language	English
Publisher	Elsevier
Publisher Date	2015-11-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Therapy Brain Brain Ischemia Acute Disease Stroke Complications Humans Middle Aged Male Aged, 80 And Over Image Processing, Computer-assisted Journal Article Pathology Magnetic Resonance Imaging Time Factors Etiology Discipline Cardiology Thrombolytic Therapy Adult Female Aged Retrospective Studies Perfusion Imaging Methods
Content Type	Text
Resource Type	Article
Subject	Rehabilitation Neurology (clinical) Surgery Cardiology and Cardiovascular Medicine

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