Aims and objectives
CT perfusion (CTP) is an important diagnostic tool in acute ischemic stroke (AIS).
We investigated if CTP may help evaluation of clinical outcome of patients who undergo intravenous (IV) thrombolysis and those who don't and if it may guide fibrinolytic treatment.
Methods and materials
285 consecutive patients (152 females and 133 males; average age of 73.9 yo) with suspect of acute ischemic stroke were retrospectively evaluated.
All performed nonenhanced CT (NECT),
CTP and NECT follow-up at 24-48 hours with a 256 slice CT scanner (Brilliance iCT 256 slices; Philips Medical System,
evaluating the amount of penumbra/core in each,
were divided into six categories of perfusion scenarios:no perfusion deficit (score 0),only penumbra (score 1),penumbra greater than core (score 2),penumbra same as core (score 3),penumbra...
Of 285 patients,
59 were excluded for several reasons (stroke mimics,
posterior circulaton strokes and technical reasons,
such as movement artifacts).
Of the remaining 226 patients,
150 (66.4%) underwent IV thrombolysis (Table 3) while 76 (33.6%) did not (Table 4).
From scores 1 to 5,
there was a progressive worsening of clinical outcome in both groups,
even if for scores 1 and 2 we observed a better radiological and clinical outcome in the group who underwent IV thrombolysis.
CTP score 0 instead had similar mRS...
Data from literature demonstrate that CT perfusion allows to identify ischemic areas in patients with AIS better than NECT and CT angiography  and it is useful in the selection of patients that could undergo endovenous thrombolysis before,
but especially after 4.5 hours from symptoms onset [2,3].
What emerges from our study is that CTP should be a guide to IV thrombolysis,
especially in patients with CTP scores 1 and 2.
When no perfusion deficits are detected,
IV thrombolysis should be evaluated for each patient...
1 Lin K,
Law M et al.
Accuracy of the Alberta Stroke Program Early CT Score during the first 3 hours of middle cerebral artery stroke: comparison of nonconstrast CT,
CT angiography source images,
and CT perfusion.
AJNR Am J Neuroradiol 2008; 29(5):931-6.
2 Hopyan J,
Dowlatshahi D et al.
Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography.
Radiology 2010; 255(1):142-53.
3 Ryu WHA,
Dharampal N et al.
Utility of perfusion imaging...