Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke
Introduction It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outc...
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| creator | Kawiorski, Michal M., MD Vicente, Agustina, MD, PhD Lourido, Daniel, MD Muriel, Alfonso, MSc, PhD Fandiño, Eduardo, MD Méndez, José C., MD Sánchez-González, Víctor, MD Aguado, Alba, MD Álvarez-Velasco, Rodrigo, MD Alonso de Leciñana, María, MD, PhD |
| description | Introduction It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outcomes. Methods A retrospective study of patients with anterior circulation stroke undergoing reperfusion therapies who had a PCT before treatment and an assessment of vessel recanalization post treatment was conducted. Tissue at risk was considered as that with reduced cerebral blood flow, whereas the infarct core was the region of reduced cerebral blood volume, the mismatch region being salvageable tissue. The volume of hypodensity in slices corresponding to perfusion acquisition cage in 24-hour computed tomography (partial lesion volume [PLV]) was measured. Outcome variables were the amount of preserved tissue, that is, the difference between volumes of tissue at risk and PLV expressed as a percentage, and the modified Rankin Scale (mRS) score at 3 months. Results Patients (n = 34) meeting the inclusion criteria were included. Vessel recanalization was associated with a larger amount of tissue at risk preserved from definite lesion (89% [interquartile range {IQR}: 76-94] versus 46% [IQR: 23-86], P |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2016.01.009 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1783917289</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1052305716000227</els_id><sourcerecordid>1783917289</sourcerecordid><originalsourceid>FETCH-LOGICAL-c459t-b41bf84dfcd8a5f6dbd41321010921756b6acac04997e6eab78277e1fad5f63c3</originalsourceid><addsrcrecordid>eNqVks-O0zAQxiMEYpeFV0A-IqQEjxPnzwVpiZalUiUQLWfLsSddd5242EmlvgZPjEMLB8SFk62Zn75PM98kyVugGVAo3-2zfZi8e0SFHjvvjjJoEzIWexmFjNLmSXINPGdpzQGexj_lLM0pr66SFyHsKQXgNX-eXLGy5mVRsuvkx71zmrTWjEZJS-SoyVepjbNu96vQOu_Rysm4kfTeDWQzRUZ6Tb6g7-ew1Fs3HOYJNdm6we28PDycyK1Ss5cT2hNZaRwn0xsMZCPtUe5QdhbJ1oQwIzEjWQX1gINRUXuZ7mXyrJc24KvLe5N8-3i3bT-l68_3q_Z2naqCN1PaFdD1daF7pWvJ-1J3uoCcxU3RhkHFy66USipaNE2FZfSsalZVCL3Ukc5VfpO8OesevPs-Y5jEYIJCa-WIbg4CqjpvoGJ1E9EPZ1R5F4LHXhy8GaQ_CaBiyUbsxb-yEUs2goKI2USR1xe_uRtQ_5H4HUYE1mcA49RHg14EZXBUqI1HNQntzP_5vf9LTl1ifsQThr2b_Rj3K0AEJqjYLNeyHAuUlFLGqvwnKm3HNA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1783917289</pqid></control><display><type>article</type><title>Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Kawiorski, Michal M., MD ; Vicente, Agustina, MD, PhD ; Lourido, Daniel, MD ; Muriel, Alfonso, MSc, PhD ; Fandiño, Eduardo, MD ; Méndez, José C., MD ; Sánchez-González, Víctor, MD ; Aguado, Alba, MD ; Álvarez-Velasco, Rodrigo, MD ; Alonso de Leciñana, María, MD, PhD</creator><creatorcontrib>Kawiorski, Michal M., MD ; Vicente, Agustina, MD, PhD ; Lourido, Daniel, MD ; Muriel, Alfonso, MSc, PhD ; Fandiño, Eduardo, MD ; Méndez, José C., MD ; Sánchez-González, Víctor, MD ; Aguado, Alba, MD ; Álvarez-Velasco, Rodrigo, MD ; Alonso de Leciñana, María, MD, PhD</creatorcontrib><description>Introduction It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outcomes. Methods A retrospective study of patients with anterior circulation stroke undergoing reperfusion therapies who had a PCT before treatment and an assessment of vessel recanalization post treatment was conducted. Tissue at risk was considered as that with reduced cerebral blood flow, whereas the infarct core was the region of reduced cerebral blood volume, the mismatch region being salvageable tissue. The volume of hypodensity in slices corresponding to perfusion acquisition cage in 24-hour computed tomography (partial lesion volume [PLV]) was measured. Outcome variables were the amount of preserved tissue, that is, the difference between volumes of tissue at risk and PLV expressed as a percentage, and the modified Rankin Scale (mRS) score at 3 months. Results Patients (n = 34) meeting the inclusion criteria were included. Vessel recanalization was associated with a larger amount of tissue at risk preserved from definite lesion (89% [interquartile range {IQR}: 76-94] versus 46% [IQR: 23-86], P < .005). The amount of preserved tissue correlated with clinical outcome at 24 hours: for each 10% of preserved tissue, the National Institutes of Health Stroke Scale score improved by 3 points (95% confidence interval [CI]: −4.9 to −.8, P = .007) and was the only predictor of independency (mRS score 0-2) following adjustment for covariates (odds ratio 1.15, 95% CI: 1.04-1.28, P = .005). Conclusions PCT provides accurate markers of viability of tissue in acute ischemic stroke and could help predict the degree of improvement following reperfusion.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.009</identifier><identifier>PMID: 26856462</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Brain Infarction - diagnostic imaging ; Brain Infarction - physiopathology ; Brain Infarction - therapy ; Cardiovascular ; Cerebral Angiography - methods ; Cerebral Arteries - diagnostic imaging ; Cerebral Arteries - physiopathology ; Cerebrovascular Circulation ; endovascular treatment ; Female ; Humans ; ischemic penumbra ; ischemic stroke ; Male ; mechanical thrombectomy ; Middle Aged ; Multidetector Computed Tomography ; Neurology ; Odds Ratio ; Perfusion computed tomography ; Perfusion Imaging - methods ; Predictive Value of Tests ; Recovery of Function ; Reperfusion ; Retrospective Studies ; thrombolysis ; Tissue Survival ; Treatment Outcome</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2016-05, Vol.25 (5), p.1062-1069</ispartof><rights>National Stroke Association</rights><rights>2016 National Stroke Association</rights><rights>Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-b41bf84dfcd8a5f6dbd41321010921756b6acac04997e6eab78277e1fad5f63c3</citedby><cites>FETCH-LOGICAL-c459t-b41bf84dfcd8a5f6dbd41321010921756b6acac04997e6eab78277e1fad5f63c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305716000227$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26856462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kawiorski, Michal M., MD</creatorcontrib><creatorcontrib>Vicente, Agustina, MD, PhD</creatorcontrib><creatorcontrib>Lourido, Daniel, MD</creatorcontrib><creatorcontrib>Muriel, Alfonso, MSc, PhD</creatorcontrib><creatorcontrib>Fandiño, Eduardo, MD</creatorcontrib><creatorcontrib>Méndez, José C., MD</creatorcontrib><creatorcontrib>Sánchez-González, Víctor, MD</creatorcontrib><creatorcontrib>Aguado, Alba, MD</creatorcontrib><creatorcontrib>Álvarez-Velasco, Rodrigo, MD</creatorcontrib><creatorcontrib>Alonso de Leciñana, María, MD, PhD</creatorcontrib><title>Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Introduction It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outcomes. Methods A retrospective study of patients with anterior circulation stroke undergoing reperfusion therapies who had a PCT before treatment and an assessment of vessel recanalization post treatment was conducted. Tissue at risk was considered as that with reduced cerebral blood flow, whereas the infarct core was the region of reduced cerebral blood volume, the mismatch region being salvageable tissue. The volume of hypodensity in slices corresponding to perfusion acquisition cage in 24-hour computed tomography (partial lesion volume [PLV]) was measured. Outcome variables were the amount of preserved tissue, that is, the difference between volumes of tissue at risk and PLV expressed as a percentage, and the modified Rankin Scale (mRS) score at 3 months. Results Patients (n = 34) meeting the inclusion criteria were included. Vessel recanalization was associated with a larger amount of tissue at risk preserved from definite lesion (89% [interquartile range {IQR}: 76-94] versus 46% [IQR: 23-86], P < .005). The amount of preserved tissue correlated with clinical outcome at 24 hours: for each 10% of preserved tissue, the National Institutes of Health Stroke Scale score improved by 3 points (95% confidence interval [CI]: −4.9 to −.8, P = .007) and was the only predictor of independency (mRS score 0-2) following adjustment for covariates (odds ratio 1.15, 95% CI: 1.04-1.28, P = .005). Conclusions PCT provides accurate markers of viability of tissue in acute ischemic stroke and could help predict the degree of improvement following reperfusion.</description><subject>Aged</subject><subject>Brain Infarction - diagnostic imaging</subject><subject>Brain Infarction - physiopathology</subject><subject>Brain Infarction - therapy</subject><subject>Cardiovascular</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebral Arteries - diagnostic imaging</subject><subject>Cerebral Arteries - physiopathology</subject><subject>Cerebrovascular Circulation</subject><subject>endovascular treatment</subject><subject>Female</subject><subject>Humans</subject><subject>ischemic penumbra</subject><subject>ischemic stroke</subject><subject>Male</subject><subject>mechanical thrombectomy</subject><subject>Middle Aged</subject><subject>Multidetector Computed Tomography</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Perfusion computed tomography</subject><subject>Perfusion Imaging - methods</subject><subject>Predictive Value of Tests</subject><subject>Recovery of Function</subject><subject>Reperfusion</subject><subject>Retrospective Studies</subject><subject>thrombolysis</subject><subject>Tissue Survival</subject><subject>Treatment Outcome</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVks-O0zAQxiMEYpeFV0A-IqQEjxPnzwVpiZalUiUQLWfLsSddd5242EmlvgZPjEMLB8SFk62Zn75PM98kyVugGVAo3-2zfZi8e0SFHjvvjjJoEzIWexmFjNLmSXINPGdpzQGexj_lLM0pr66SFyHsKQXgNX-eXLGy5mVRsuvkx71zmrTWjEZJS-SoyVepjbNu96vQOu_Rysm4kfTeDWQzRUZ6Tb6g7-ew1Fs3HOYJNdm6we28PDycyK1Ss5cT2hNZaRwn0xsMZCPtUe5QdhbJ1oQwIzEjWQX1gINRUXuZ7mXyrJc24KvLe5N8-3i3bT-l68_3q_Z2naqCN1PaFdD1daF7pWvJ-1J3uoCcxU3RhkHFy66USipaNE2FZfSsalZVCL3Ukc5VfpO8OesevPs-Y5jEYIJCa-WIbg4CqjpvoGJ1E9EPZ1R5F4LHXhy8GaQ_CaBiyUbsxb-yEUs2goKI2USR1xe_uRtQ_5H4HUYE1mcA49RHg14EZXBUqI1HNQntzP_5vf9LTl1ifsQThr2b_Rj3K0AEJqjYLNeyHAuUlFLGqvwnKm3HNA</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Kawiorski, Michal M., MD</creator><creator>Vicente, Agustina, MD, PhD</creator><creator>Lourido, Daniel, MD</creator><creator>Muriel, Alfonso, MSc, PhD</creator><creator>Fandiño, Eduardo, MD</creator><creator>Méndez, José C., MD</creator><creator>Sánchez-González, Víctor, MD</creator><creator>Aguado, Alba, MD</creator><creator>Álvarez-Velasco, Rodrigo, MD</creator><creator>Alonso de Leciñana, María, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke</title><author>Kawiorski, Michal M., MD ; Vicente, Agustina, MD, PhD ; Lourido, Daniel, MD ; Muriel, Alfonso, MSc, PhD ; Fandiño, Eduardo, MD ; Méndez, José C., MD ; Sánchez-González, Víctor, MD ; Aguado, Alba, MD ; Álvarez-Velasco, Rodrigo, MD ; Alonso de Leciñana, María, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-b41bf84dfcd8a5f6dbd41321010921756b6acac04997e6eab78277e1fad5f63c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Brain Infarction - diagnostic imaging</topic><topic>Brain Infarction - physiopathology</topic><topic>Brain Infarction - therapy</topic><topic>Cardiovascular</topic><topic>Cerebral Angiography - methods</topic><topic>Cerebral Arteries - diagnostic imaging</topic><topic>Cerebral Arteries - physiopathology</topic><topic>Cerebrovascular Circulation</topic><topic>endovascular treatment</topic><topic>Female</topic><topic>Humans</topic><topic>ischemic penumbra</topic><topic>ischemic stroke</topic><topic>Male</topic><topic>mechanical thrombectomy</topic><topic>Middle Aged</topic><topic>Multidetector Computed Tomography</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Perfusion computed tomography</topic><topic>Perfusion Imaging - methods</topic><topic>Predictive Value of Tests</topic><topic>Recovery of Function</topic><topic>Reperfusion</topic><topic>Retrospective Studies</topic><topic>thrombolysis</topic><topic>Tissue Survival</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kawiorski, Michal M., MD</creatorcontrib><creatorcontrib>Vicente, Agustina, MD, PhD</creatorcontrib><creatorcontrib>Lourido, Daniel, MD</creatorcontrib><creatorcontrib>Muriel, Alfonso, MSc, PhD</creatorcontrib><creatorcontrib>Fandiño, Eduardo, MD</creatorcontrib><creatorcontrib>Méndez, José C., MD</creatorcontrib><creatorcontrib>Sánchez-González, Víctor, MD</creatorcontrib><creatorcontrib>Aguado, Alba, MD</creatorcontrib><creatorcontrib>Álvarez-Velasco, Rodrigo, MD</creatorcontrib><creatorcontrib>Alonso de Leciñana, María, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kawiorski, Michal M., MD</au><au>Vicente, Agustina, MD, PhD</au><au>Lourido, Daniel, MD</au><au>Muriel, Alfonso, MSc, PhD</au><au>Fandiño, Eduardo, MD</au><au>Méndez, José C., MD</au><au>Sánchez-González, Víctor, MD</au><au>Aguado, Alba, MD</au><au>Álvarez-Velasco, Rodrigo, MD</au><au>Alonso de Leciñana, María, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>25</volume><issue>5</issue><spage>1062</spage><epage>1069</epage><pages>1062-1069</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Introduction It has been debated whether the penumbral pattern, as identified using multimodal imaging, is a specific marker of tissue viability in ischemic stroke. We assessed whether perfusion computed tomography (PCT) accurately identifies salvageable tissue and helps predict postreperfusion outcomes. Methods A retrospective study of patients with anterior circulation stroke undergoing reperfusion therapies who had a PCT before treatment and an assessment of vessel recanalization post treatment was conducted. Tissue at risk was considered as that with reduced cerebral blood flow, whereas the infarct core was the region of reduced cerebral blood volume, the mismatch region being salvageable tissue. The volume of hypodensity in slices corresponding to perfusion acquisition cage in 24-hour computed tomography (partial lesion volume [PLV]) was measured. Outcome variables were the amount of preserved tissue, that is, the difference between volumes of tissue at risk and PLV expressed as a percentage, and the modified Rankin Scale (mRS) score at 3 months. Results Patients (n = 34) meeting the inclusion criteria were included. Vessel recanalization was associated with a larger amount of tissue at risk preserved from definite lesion (89% [interquartile range {IQR}: 76-94] versus 46% [IQR: 23-86], P < .005). The amount of preserved tissue correlated with clinical outcome at 24 hours: for each 10% of preserved tissue, the National Institutes of Health Stroke Scale score improved by 3 points (95% confidence interval [CI]: −4.9 to −.8, P = .007) and was the only predictor of independency (mRS score 0-2) following adjustment for covariates (odds ratio 1.15, 95% CI: 1.04-1.28, P = .005). Conclusions PCT provides accurate markers of viability of tissue in acute ischemic stroke and could help predict the degree of improvement following reperfusion.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26856462</pmid><doi>10.1016/j.jstrokecerebrovasdis.2016.01.009</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Brain Infarction - diagnostic imaging Brain Infarction - physiopathology Brain Infarction - therapy Cardiovascular Cerebral Angiography - methods Cerebral Arteries - diagnostic imaging Cerebral Arteries - physiopathology Cerebrovascular Circulation endovascular treatment Female Humans ischemic penumbra ischemic stroke Male mechanical thrombectomy Middle Aged Multidetector Computed Tomography Neurology Odds Ratio Perfusion computed tomography Perfusion Imaging - methods Predictive Value of Tests Recovery of Function Reperfusion Retrospective Studies thrombolysis Tissue Survival Treatment Outcome |
| title | Good Clinical and Radiological Correlation from Standard Perfusion Computed Tomography Accurately Identifies Salvageable Tissue in Ischemic Stroke |
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