Introduction: Optimal treatment on the hyper-acute phase of ischaemic stroke is aimed at ensuring reperfusion and survival of viable brain tissue at the margin of the ischaemic event. Although DWI has been validated as highly accurate for the identification of infarct core, the accurate identification of ischaemic penumbra remains elusive.
Hypothesis: To determine whether Ktrans maps, a permeability parameter indicating BBB dysfunction, combining with perfusion parameters, can identify the really ischaemic penumbra and predict the clinical outcome in acute ischemic stroke.
Method: Consecutive patients admitted with signs and symptoms suggesting acute hemispheric stroke. Ktrans maps were calculated from PCT data using prototype software, which uses the Patlak model to assess their BBBP. Then Ktrans maps were loaded into ImageJ 1.47 for Mac OS to draw the Regions of interest. The agreements between different groups were calculated using Chi-square tests. The radiological calculated both perfusion and Ktrans maps. Multiple logistic regression analyse and linear regression model were conducted to determine independent predictors of 90-day mRS and FUP-FIV, respectively.
Result: Of 98 patients, 46 was female. Mean age of all patients was 65.03±14.1 years. Patients with good outcome had less mean age, NIHSS, PCT-FIV, Ktrans-FIV, FUP-FIV P<0.001). Patients with poor outcome had higher mean SBP on admission(P=0.003) and less opportunity of successful recanalization(P=0.003). In regression analyses, Ktrans-FIV was the most powerful predictor of clinical outcome(P=0.009, OR=1.097), and also the best positive predictors for FUP-FIV (F=75.590, P<0.0001).
Conclusions: Combining PCT and Ktrans maps derived from first-pass of PCT can identify cerebral ischemic tissue at risk more precisely than using perfusion parameters alone.