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Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?

PURPOSE: CT-based perfusion and collateral imaging is increasingly used in the assessment of patients with acute stroke. Time of stroke onset is a critical factor in determining eligibility for and benefit from thrombolysis. Animal studies predict that the volume of ischemic penumbra decreases with...

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Autores principales: Agarwal, Smriti, Matys, Tomasz, Marrapu, S. Tulasi, Scoffings, Daniel J., Mitchell, Jennifer, Jones, P. Simon, Baron, Jean-Claude, Warburton, Elizabeth A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391339/
https://www.ncbi.nlm.nih.gov/pubmed/25914673
http://dx.doi.org/10.3389/fneur.2015.00070
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author Agarwal, Smriti
Matys, Tomasz
Marrapu, S. Tulasi
Scoffings, Daniel J.
Mitchell, Jennifer
Jones, P. Simon
Baron, Jean-Claude
Warburton, Elizabeth A.
author_facet Agarwal, Smriti
Matys, Tomasz
Marrapu, S. Tulasi
Scoffings, Daniel J.
Mitchell, Jennifer
Jones, P. Simon
Baron, Jean-Claude
Warburton, Elizabeth A.
author_sort Agarwal, Smriti
collection PubMed
description PURPOSE: CT-based perfusion and collateral imaging is increasingly used in the assessment of patients with acute stroke. Time of stroke onset is a critical factor in determining eligibility for and benefit from thrombolysis. Animal studies predict that the volume of ischemic penumbra decreases with time. Here, we evaluate if CT is able to detect a relationship between perfusion or collateral status, as assessed by CT, and time since stroke onset. MATERIALS AND METHODS: We studied 53 consecutive patients with proximal vessel occlusions, mean (SD) age of 71.3 (14.9) years, at a mean (SD) of 125.2 (55.3) minutes from onset, using whole-brain CT perfusion (CTp) imaging. Penumbra was defined using voxel-based thresholds for cerebral blood flow (CBF) and mean transit time (MTT); core was defined by cerebral blood volume (CBV). Normalized penumbra fraction was calculated as Penumbra volume/(Penumbra volume + Core volume) for both CBF and MTT (Pen(CBF) and Pen(MTT), respectively). Collaterals were assessed on CT angiography (CTA). CTp ASPECTS score was applied visually, lower scores indicating larger lesions. ASPECTS ratios were calculated corresponding to penumbra fractions. RESULTS: Both Pen(CBF) and Pen(MTT) showed decremental trends with increasing time since onset (Kendall’s tau-b = −0.196, p = 0.055, and −0.187, p = 0.068, respectively). The CBF/CBV ASPECTS ratio, which showed a relationship to Pen(CBF) (Kendall’s tau-b = 0.190, p = 0.070), decreased with increasing time since onset (Kendall’s tau-b = −0.265, p = 0.006). Collateral response did not relate to time (Kendall’s tau-b = −0.039, p = 0.724). CONCLUSION: Even within 4.5 h since stroke onset, a decremental relationship between penumbra and time, but not between collateral status and time, may be detected using perfusion CT imaging. The trends that we demonstrate merit evaluation in larger datasets to confirm our results, which may have potential wider applications, e.g., in the setting of strokes of unknown onset time.
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spelling pubmed-43913392015-04-24 Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset? Agarwal, Smriti Matys, Tomasz Marrapu, S. Tulasi Scoffings, Daniel J. Mitchell, Jennifer Jones, P. Simon Baron, Jean-Claude Warburton, Elizabeth A. Front Neurol Neuroscience PURPOSE: CT-based perfusion and collateral imaging is increasingly used in the assessment of patients with acute stroke. Time of stroke onset is a critical factor in determining eligibility for and benefit from thrombolysis. Animal studies predict that the volume of ischemic penumbra decreases with time. Here, we evaluate if CT is able to detect a relationship between perfusion or collateral status, as assessed by CT, and time since stroke onset. MATERIALS AND METHODS: We studied 53 consecutive patients with proximal vessel occlusions, mean (SD) age of 71.3 (14.9) years, at a mean (SD) of 125.2 (55.3) minutes from onset, using whole-brain CT perfusion (CTp) imaging. Penumbra was defined using voxel-based thresholds for cerebral blood flow (CBF) and mean transit time (MTT); core was defined by cerebral blood volume (CBV). Normalized penumbra fraction was calculated as Penumbra volume/(Penumbra volume + Core volume) for both CBF and MTT (Pen(CBF) and Pen(MTT), respectively). Collaterals were assessed on CT angiography (CTA). CTp ASPECTS score was applied visually, lower scores indicating larger lesions. ASPECTS ratios were calculated corresponding to penumbra fractions. RESULTS: Both Pen(CBF) and Pen(MTT) showed decremental trends with increasing time since onset (Kendall’s tau-b = −0.196, p = 0.055, and −0.187, p = 0.068, respectively). The CBF/CBV ASPECTS ratio, which showed a relationship to Pen(CBF) (Kendall’s tau-b = 0.190, p = 0.070), decreased with increasing time since onset (Kendall’s tau-b = −0.265, p = 0.006). Collateral response did not relate to time (Kendall’s tau-b = −0.039, p = 0.724). CONCLUSION: Even within 4.5 h since stroke onset, a decremental relationship between penumbra and time, but not between collateral status and time, may be detected using perfusion CT imaging. The trends that we demonstrate merit evaluation in larger datasets to confirm our results, which may have potential wider applications, e.g., in the setting of strokes of unknown onset time. Frontiers Media S.A. 2015-04-09 /pmc/articles/PMC4391339/ /pubmed/25914673 http://dx.doi.org/10.3389/fneur.2015.00070 Text en Copyright © 2015 Agarwal, Matys, Marrapu, Scoffings, Mitchell, Jones, Baron and Warburton. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Agarwal, Smriti
Matys, Tomasz
Marrapu, S. Tulasi
Scoffings, Daniel J.
Mitchell, Jennifer
Jones, P. Simon
Baron, Jean-Claude
Warburton, Elizabeth A.
Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title_full Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title_fullStr Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title_full_unstemmed Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title_short Is CT-Based Perfusion and Collateral Imaging Sensitive to Time Since Stroke Onset?
title_sort is ct-based perfusion and collateral imaging sensitive to time since stroke onset?
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391339/
https://www.ncbi.nlm.nih.gov/pubmed/25914673
http://dx.doi.org/10.3389/fneur.2015.00070
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