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Computed tomography perfusion in detecting malignant middle cerebral artery infarct

BACKGROUND: Computed tomography perfusion (CTP) is an emerging modality which produces maps of time-to- peak (TTP), cerebral blood flow (CBF), and cerebral blood volume (CBV), with a computerized automated map of the infarct and penumbra. This modality provides a better evaluation of the extent of i...

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Autores principales: Lee, Chun Lin, Kandasamy, Regunath, Mohammad Raffiq, Mohammed Azman Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744784/
https://www.ncbi.nlm.nih.gov/pubmed/31528494
http://dx.doi.org/10.25259/SNI_64_2019
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author Lee, Chun Lin
Kandasamy, Regunath
Mohammad Raffiq, Mohammed Azman Bin
author_facet Lee, Chun Lin
Kandasamy, Regunath
Mohammad Raffiq, Mohammed Azman Bin
author_sort Lee, Chun Lin
collection PubMed
description BACKGROUND: Computed tomography perfusion (CTP) is an emerging modality which produces maps of time-to- peak (TTP), cerebral blood flow (CBF), and cerebral blood volume (CBV), with a computerized automated map of the infarct and penumbra. This modality provides a better evaluation of the extent of infarction, making it a potential method for assessing patients suffering from large middle cerebral artery (MCA) infarctions. METHODS: A prospective cohort study of all patients in Hospital Kuala Lumpur, Malaysia, who presented with the clinical diagnosis of a large MCA infarction within 48 h of onset were subjected to CT brain, and CTP scans on admission and were followed up to determine the development of malignant infarction requiring surgical decompression. RESULTS: CTP parameters were generally lower in patients with malignant brain infarct (MBI) group compared to the nonMBI group. The largest mean difference between the group was noted in the TTP values (P = 0.005). CTP parameters had a comparable positive predictive value (83%–90%) and high net present value (88–93). CBF with cutoff value of >32.85 of the hemisphere could accurately predict malignant infarctions in 81.4% of cases. The National Institutes of Health Stroke Scale score of more than 13.5 was also found to be able to accurately determine malignant infarct (97.6%). Functional outcome of patients based on Glasgow outcome scale was similar on discharge, however, showed improvement at 6 months during reviewed base on modified Rankin scale (P < 0.001). CONCLUSION: CTP parameters should be included in the initial evaluation of patients to predict malignant brain infarction and facilitate surgical treatment of large MCA infarctions. KEY MESSAGES: CT perfusion parameters have an important role in predicting malignant brain infarction and should be included in the initial evaluation of patients to facilitate the early identification and surgical treatment of large middle cerebral artery infarctions, to improve patient’s prognosis.
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spelling pubmed-67447842019-09-16 Computed tomography perfusion in detecting malignant middle cerebral artery infarct Lee, Chun Lin Kandasamy, Regunath Mohammad Raffiq, Mohammed Azman Bin Surg Neurol Int Original Article BACKGROUND: Computed tomography perfusion (CTP) is an emerging modality which produces maps of time-to- peak (TTP), cerebral blood flow (CBF), and cerebral blood volume (CBV), with a computerized automated map of the infarct and penumbra. This modality provides a better evaluation of the extent of infarction, making it a potential method for assessing patients suffering from large middle cerebral artery (MCA) infarctions. METHODS: A prospective cohort study of all patients in Hospital Kuala Lumpur, Malaysia, who presented with the clinical diagnosis of a large MCA infarction within 48 h of onset were subjected to CT brain, and CTP scans on admission and were followed up to determine the development of malignant infarction requiring surgical decompression. RESULTS: CTP parameters were generally lower in patients with malignant brain infarct (MBI) group compared to the nonMBI group. The largest mean difference between the group was noted in the TTP values (P = 0.005). CTP parameters had a comparable positive predictive value (83%–90%) and high net present value (88–93). CBF with cutoff value of >32.85 of the hemisphere could accurately predict malignant infarctions in 81.4% of cases. The National Institutes of Health Stroke Scale score of more than 13.5 was also found to be able to accurately determine malignant infarct (97.6%). Functional outcome of patients based on Glasgow outcome scale was similar on discharge, however, showed improvement at 6 months during reviewed base on modified Rankin scale (P < 0.001). CONCLUSION: CTP parameters should be included in the initial evaluation of patients to predict malignant brain infarction and facilitate surgical treatment of large MCA infarctions. KEY MESSAGES: CT perfusion parameters have an important role in predicting malignant brain infarction and should be included in the initial evaluation of patients to facilitate the early identification and surgical treatment of large middle cerebral artery infarctions, to improve patient’s prognosis. Scientific Scholar 2019-08-09 /pmc/articles/PMC6744784/ /pubmed/31528494 http://dx.doi.org/10.25259/SNI_64_2019 Text en Copyright: © 2019 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Lee, Chun Lin
Kandasamy, Regunath
Mohammad Raffiq, Mohammed Azman Bin
Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title_full Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title_fullStr Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title_full_unstemmed Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title_short Computed tomography perfusion in detecting malignant middle cerebral artery infarct
title_sort computed tomography perfusion in detecting malignant middle cerebral artery infarct
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744784/
https://www.ncbi.nlm.nih.gov/pubmed/31528494
http://dx.doi.org/10.25259/SNI_64_2019
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