Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements
We investigated whether computed tomography (CT) perfusion-derived cerebral blood flow (CBF) and cerebral blood volume (CBV) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients. Thirty patients underwent a noncontrast CT...
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| Veröffentlicht in: | Stroke (1970) 2006-07, Vol.37 (7), p.1771-1777 |
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| creator | MURPHY, B. D FOX, A. J SYMONS, S GULKA, I. B BELETSKY, V PELZ, D HACHINSKI, V CHAN, R LEE, T.-Y LEE, D. H SAHLAS, D. J BLACK, S. E HOGAN, M. J COUTTS, S. B DEMCHUK, A. M GOYAL, M AVIV, R. I |
| description | We investigated whether computed tomography (CT) perfusion-derived cerebral blood flow (CBF) and cerebral blood volume (CBV) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients.
Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days. Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups: those with recanalization at 24 hours (n=16) and those without (n=9). Penumbra was operationally defined as tissue with an admission CBF |
| doi_str_mv | 10.1161/01.STR.0000227243.96808.53 |
| format | Article |
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Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days. Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups: those with recanalization at 24 hours (n=16) and those without (n=9). Penumbra was operationally defined as tissue with an admission CBF <25 mL x 100 g(-1) x min(-1) that was not infarcted on the 5- to 7-day NCCT. Logistic regression was applied to differentiate between infarct and penumbra data points.
For recanalized patients, CBF was significantly lower (P<0.05) for infarct (13.3+/-3.75 mL x 100 g(-1) x min(-1)) than penumbra (25.0+/-3.82 mL x 100 g(-1) x min(-1)). CBV in the penumbra (2.15+/-0.43 mL x 100 g(-1)) was significantly higher than contralateral (1.78+/-0.30 mL x 100 g(-1)) and infarcted tissue (1.12+/-0.37 mL x 100 g(-1)). Logistic regression using an interaction term (CBFxCBV) resulted in sensitivity, specificity, and accuracy of 97.0%, 97.2%, and 97.1%, respectively. The interaction term resulted in a significantly better (P<0.05) fit than CBF or CBV alone, suggesting that the CBV threshold for infarction varies with CBF. For patients without recanalization, CBF and CBV for infarcted regions were 15.1+/-5.67 mL x 100 g(-1) x min(-1) and 1.17+/-0.41 mL x 100 g(-1), respectively.
We have shown in a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000227243.96808.53</identifier><identifier>PMID: 16763182</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood Flow Velocity ; Blood Volume ; Brain Ischemia - diagnostic imaging ; Brain Ischemia - physiopathology ; Cell Survival ; Cerebral Angiography - methods ; Cerebrovascular Circulation ; Female ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Image Processing, Computer-Assisted ; Infarction, Middle Cerebral Artery - diagnostic imaging ; Infarction, Middle Cerebral Artery - physiopathology ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Nervous system ; Nervous system (semeiology, syndromes) ; Neurology ; Perfusion ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Reperfusion ; Sensitivity and Specificity ; Tomography, X-Ray Computed - methods ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2006-07, Vol.37 (7), p.1771-1777</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c537t-129607199cdd1fa81fe64a15507428fd588016b3ca07dc1fa1452c6610db0ecd3</citedby><cites>FETCH-LOGICAL-c537t-129607199cdd1fa81fe64a15507428fd588016b3ca07dc1fa1452c6610db0ecd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17920050$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16763182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MURPHY, B. D</creatorcontrib><creatorcontrib>FOX, A. J</creatorcontrib><creatorcontrib>SYMONS, S</creatorcontrib><creatorcontrib>GULKA, I. B</creatorcontrib><creatorcontrib>BELETSKY, V</creatorcontrib><creatorcontrib>PELZ, D</creatorcontrib><creatorcontrib>HACHINSKI, V</creatorcontrib><creatorcontrib>CHAN, R</creatorcontrib><creatorcontrib>LEE, T.-Y</creatorcontrib><creatorcontrib>LEE, D. H</creatorcontrib><creatorcontrib>SAHLAS, D. J</creatorcontrib><creatorcontrib>BLACK, S. E</creatorcontrib><creatorcontrib>HOGAN, M. J</creatorcontrib><creatorcontrib>COUTTS, S. B</creatorcontrib><creatorcontrib>DEMCHUK, A. M</creatorcontrib><creatorcontrib>GOYAL, M</creatorcontrib><creatorcontrib>AVIV, R. I</creatorcontrib><title>Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>We investigated whether computed tomography (CT) perfusion-derived cerebral blood flow (CBF) and cerebral blood volume (CBV) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients.
Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days. Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups: those with recanalization at 24 hours (n=16) and those without (n=9). Penumbra was operationally defined as tissue with an admission CBF <25 mL x 100 g(-1) x min(-1) that was not infarcted on the 5- to 7-day NCCT. Logistic regression was applied to differentiate between infarct and penumbra data points.
For recanalized patients, CBF was significantly lower (P<0.05) for infarct (13.3+/-3.75 mL x 100 g(-1) x min(-1)) than penumbra (25.0+/-3.82 mL x 100 g(-1) x min(-1)). CBV in the penumbra (2.15+/-0.43 mL x 100 g(-1)) was significantly higher than contralateral (1.78+/-0.30 mL x 100 g(-1)) and infarcted tissue (1.12+/-0.37 mL x 100 g(-1)). Logistic regression using an interaction term (CBFxCBV) resulted in sensitivity, specificity, and accuracy of 97.0%, 97.2%, and 97.1%, respectively. The interaction term resulted in a significantly better (P<0.05) fit than CBF or CBV alone, suggesting that the CBV threshold for infarction varies with CBF. For patients without recanalization, CBF and CBV for infarcted regions were 15.1+/-5.67 mL x 100 g(-1) x min(-1) and 1.17+/-0.41 mL x 100 g(-1), respectively.
We have shown in a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Blood Volume</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - physiopathology</subject><subject>Cell Survival</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebrovascular Circulation</subject><subject>Female</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Image Processing, Computer-Assisted</subject><subject>Infarction, Middle Cerebral Artery - diagnostic imaging</subject><subject>Infarction, Middle Cerebral Artery - physiopathology</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Perfusion</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Reperfusion</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkd1qFTEUhYMo9rT6ChIEvZsxP5NM4p2UagsFQet1yOSnjU6SMZmp9D18YNOeA-fS3GzC-vbaO1kAvMWox5jjDwj332--9agdQkYy0F5ygUTP6DOww4wM3cCJeA52CFHZkUHKE3Ba689Hngr2EpxgPnKKBdmBv1fWpTX4YPQacoLZw8WlLU5FQ50sDMnrYtZWoTbb6mCo5s7FYGBdS_7l4FZDuoUmx6WpFq455tuil7uH5lN8U3PqrCvhvonTnLOFfs5_nrz31_s8b9HB6HTdiottm_oKvPB6ru71oZ6BH58vbs4vu-uvX67OP113htFx7TCRHI1YSmMt9lpg7_igMWNoHIjwlgmBMJ-o0Wi0phF4YMRwjpGdkDOWnoH3e9-l5N-bq6uK7XlunnVyeauKCyY4kfi_YNtBtA-VDfy4B03JtRbn1VJC1OVBYaQew1MIqxaeOoannsJTjLbmN4cp2xSdPbYe0mrAuwOgq9GzLzqZUI_cKAlCDNF_FjGmbQ</recordid><startdate>20060701</startdate><enddate>20060701</enddate><creator>MURPHY, B. D</creator><creator>FOX, A. J</creator><creator>SYMONS, S</creator><creator>GULKA, I. B</creator><creator>BELETSKY, V</creator><creator>PELZ, D</creator><creator>HACHINSKI, V</creator><creator>CHAN, R</creator><creator>LEE, T.-Y</creator><creator>LEE, D. H</creator><creator>SAHLAS, D. J</creator><creator>BLACK, S. E</creator><creator>HOGAN, M. J</creator><creator>COUTTS, S. B</creator><creator>DEMCHUK, A. M</creator><creator>GOYAL, M</creator><creator>AVIV, R. I</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><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>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20060701</creationdate><title>Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements</title><author>MURPHY, B. D ; FOX, A. J ; SYMONS, S ; GULKA, I. B ; BELETSKY, V ; PELZ, D ; HACHINSKI, V ; CHAN, R ; LEE, T.-Y ; LEE, D. H ; SAHLAS, D. J ; BLACK, S. E ; HOGAN, M. J ; COUTTS, S. B ; DEMCHUK, A. M ; GOYAL, M ; AVIV, R. 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Cerebral palsy</topic><topic>Humans</topic><topic>Image Processing, Computer-Assisted</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - physiopathology</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Perfusion</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Reperfusion</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MURPHY, B. D</creatorcontrib><creatorcontrib>FOX, A. 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I</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MURPHY, B. D</au><au>FOX, A. J</au><au>SYMONS, S</au><au>GULKA, I. B</au><au>BELETSKY, V</au><au>PELZ, D</au><au>HACHINSKI, V</au><au>CHAN, R</au><au>LEE, T.-Y</au><au>LEE, D. H</au><au>SAHLAS, D. J</au><au>BLACK, S. E</au><au>HOGAN, M. J</au><au>COUTTS, S. B</au><au>DEMCHUK, A. M</au><au>GOYAL, M</au><au>AVIV, R. I</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2006-07-01</date><risdate>2006</risdate><volume>37</volume><issue>7</issue><spage>1771</spage><epage>1777</epage><pages>1771-1777</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>We investigated whether computed tomography (CT) perfusion-derived cerebral blood flow (CBF) and cerebral blood volume (CBV) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients.
Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days. Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups: those with recanalization at 24 hours (n=16) and those without (n=9). Penumbra was operationally defined as tissue with an admission CBF <25 mL x 100 g(-1) x min(-1) that was not infarcted on the 5- to 7-day NCCT. Logistic regression was applied to differentiate between infarct and penumbra data points.
For recanalized patients, CBF was significantly lower (P<0.05) for infarct (13.3+/-3.75 mL x 100 g(-1) x min(-1)) than penumbra (25.0+/-3.82 mL x 100 g(-1) x min(-1)). CBV in the penumbra (2.15+/-0.43 mL x 100 g(-1)) was significantly higher than contralateral (1.78+/-0.30 mL x 100 g(-1)) and infarcted tissue (1.12+/-0.37 mL x 100 g(-1)). Logistic regression using an interaction term (CBFxCBV) resulted in sensitivity, specificity, and accuracy of 97.0%, 97.2%, and 97.1%, respectively. The interaction term resulted in a significantly better (P<0.05) fit than CBF or CBV alone, suggesting that the CBV threshold for infarction varies with CBF. For patients without recanalization, CBF and CBV for infarcted regions were 15.1+/-5.67 mL x 100 g(-1) x min(-1) and 1.17+/-0.41 mL x 100 g(-1), respectively.
We have shown in a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16763182</pmid><doi>10.1161/01.STR.0000227243.96808.53</doi><tpages>7</tpages></addata></record> |
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| ispartof | Stroke (1970), 2006-07, Vol.37 (7), p.1771-1777 |
| issn | 0039-2499 1524-4628 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Acute Disease Adult Aged Aged, 80 and over Biological and medical sciences Blood Flow Velocity Blood Volume Brain Ischemia - diagnostic imaging Brain Ischemia - physiopathology Cell Survival Cerebral Angiography - methods Cerebrovascular Circulation Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Image Processing, Computer-Assisted Infarction, Middle Cerebral Artery - diagnostic imaging Infarction, Middle Cerebral Artery - physiopathology Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Nervous system Nervous system (semeiology, syndromes) Neurology Perfusion Radiodiagnosis. Nmr imagery. Nmr spectrometry Reperfusion Sensitivity and Specificity Tomography, X-Ray Computed - methods Vascular diseases and vascular malformations of the nervous system |
| title | Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements |
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