Perfusion computed tomography in posterior circulation stroke: predictors and prognostic implications of focal hypoperfusion
- 1 May 2018
- journal article
- research article
- Published by Wiley in European Journal of Neurology
- Vol. 25 (5), 725-731
- https://doi.org/10.1111/ene.13578
Abstract
Background and purposeThe aim was to determine the predictors of focal hypoperfusion on computed tomography (CT) perfusion (CTP) in patients with acute posterior circulation stroke and its association with long-term outcome. MethodsPatients with posterior circulation stroke were selected from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) who underwent CTP within 24h of stroke onset as part of the stroke imaging protocol. Hypoperfusion was defined as an area of visually well demarcated mean transit time prolongation corresponding to an arterial territory on standard reconstruction CTP imaging maps. Areas of hypoperfusion were assessed with the posterior circulation Acute Stroke Prognosis Early CT Score. Clinical and imaging associations with focal hypoperfusion were identified using multiple imputation analyses, and the adjusted functional outcome measured by the modified Rankin Scale at 3 and 12months was determined. ResultsOf the 3595 consecutive patients from the ASTRAL registry between 2003 and 2014, 1070 (29.7%) had a posterior circulation stroke and 436 of these (40.7%) patients had a good quality baseline CTP. 23.1% had early ischaemic changes and 37.4% had focal hypoperfusion. In multiple imputation analysis, visual field deficits, reduced level of consciousness, cardiac and multiple stroke mechanisms, significant vessel pathology and ischaemic changes visible on plain CT were associated with focal hypoperfusion. Focal hypoperfusion was independently associated with outcome at 12months (odds ratio 2.04, 95% confidence interval 1.22-3.42, P<0.01). ConclusionsIn posterior circulation stroke patients undergoing acute CTP, multiple clinical, aetiological and radiological variables were associated with focal hypoperfusion. Patients with focal hypoperfusion had a worse 12-month outcome.Funding Information
- EAN Department−Department Cooperation Programme
This publication has 14 references indexed in Scilit:
- The predictive value of a targeted posterior fossa multimodal stroke protocol for the diagnosis of acute posterior ischemic strokeNeurovascular Imaging, 2016
- Acute stroke chameleons in a university hospitalNeurology, 2015
- Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior CirculationStroke, 2015
- Multimodal Computed Tomography Based Definition of Cerebral Imaging Profiles for Acute Stroke Reperfusion Therapy (CT-DEFINE): Results of a Prospective Observational StudyClinical Neuroradiology, 2014
- Diagnostic and Prognostic Impact of pc‐ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation StudyJournal of Neuroimaging, 2014
- Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current ManagementFrontiers in Neurology, 2014
- Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary preventionThe Lancet Neurology, 2013
- The Acute STroke Registry and Analysis of Lausanne (ASTRAL)Stroke, 2010
- Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery OcclusionStroke, 2008
- Magnetic resonance brain imaging in patients with acute stroke: feasibility and patient related difficultiesJournal of Neurology, Neurosurgery & Psychiatry, 2005