Accuracy of perfusion-CT inpredicting malignant middle cerebral artery brain infarction

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We performeda prospective study on patientswith middle cerebral artery(MCA) ischemic stroke to evaluatethe accuracy of perfusion-CT imaging(PCT) to predict the developmentof malignant brain infarction(MBI).


106 patients(women 37 %, mean age 65 years)underwent native cranial computedtomography (CCT), CT angiography(CTA) and PCT after a medianof 2 h after stroke onset. We assessedthe patency of the MCA andthe area of tissue ischemia (AIT)according to cerebral blood flow(CBF), cerebral blood volume(CBV) and time-to-peak (TTP)maps. Optimum sensitivity, specificity,positive (PPV) and negativepredictive values (NPV) were calculatedfor the end-point MBI(= midline shift > 5 mm or decompressivesurgery) by means of receiveroperating characteristics(ROC).


20 patients (19 %)developed a MBI. In these patients,a larger AIT was found in all perfusionmaps as compared to the remainingpatients (p < 0.001). Allperfusion maps had a very highNPV (95.4-98.4 %), a high sensitivity(85-95 %) and specificity (71.6-77.9 %) and only a moderate PPV(44-47.4 %). Best prediction wasfound for CBF maps with AIT of> 27.9 % of the hemisphere.


PCT allows the discriminationof patients without a relevant riskfor MBI from those having a 50 %risk of MBI development. Due tothe high sensitivity and specificity,PCT is a reliable tool in detectingMBI. Because of PCT's better availability,it is the method of choice atpresent for an early risk stratificationof acute stroke patients.

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