en
Scientific article
English

Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome

Published inJournal of neuroradiology, vol. 36, no. 3, p. 131-137
Publication date2009
Abstract

OBJECTIVE: To evaluate the prognostic accuracy of combining perfusion CT (PCT) and thrombolysis in brain ischemia (TIBI) ultrasonographic grade in the triage of stroke patients who will benefit from thrombolysis and in predicting the clinical outcome. METHODS: We conducted a prospective study of all consecutive stroke patients admitted to our hospital from March 2003 to July 2007, presenting with signs of acute stroke within the therapeutic window, who had undergone either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated by a complete stroke CT protocol, transcranial color-coded duplex sonographic monitoring, follow-up imaging (CT or MRI) and clinical outcome at 3 months, as assessed by the modified Rankin scale (mRS). RESULTS: A total of 34 patients were included with a mean NIHSS on admission of 14.2. This study revealed that PCT had 95% sensitivity and 71% specificity in the evaluation of therapy benefit as well as 75% sensitivity and 39% specificity in predicting clinical outcome. The extent of ischemic tissue according to PCT and TIBI grade were significantly correlated (p<0.05). Using the MTT-TTP approach was an alternative to the classical MTT-CBV approach for determining tissue at risk. The clinical outcome assessed by the mRS was considered favorable (mRS 0-2) in 16 patients and unfavorable (mRS>2) in 18 patients. CONCLUSION: PCT was the most accurate predictor of both thrombolytic therapy benefit and clinical outcome. The TIBI score was useful for determining whether or not to perform intravenous therapy alone or as a combined therapy.

Keywords
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia/complications/*diagnosis/*therapy
  • Cerebrovascular Circulation
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • *Perfusion Imaging
  • Predictive Value of Tests
  • Stroke/*diagnosis/etiology/therapy
  • *Thrombolytic Therapy
  • *Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Doppler, Transcranial
Citation (ISO format)
KNOEPFLI, Anne-Sophie et al. Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome. In: Journal of neuroradiology, 2009, vol. 36, n° 3, p. 131–137. doi: 10.1016/j.neurad.2008.10.003
Identifiers
ISSN of the journal0150-9861
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