CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy |
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Authors: | Nan Liu Hui Chen Bing Wu Ying Li Max Wintermark Alan Jackson Jun Hu Yongwei Zhang Zihua Su Guangming Zhu Weiwei Zhang |
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Institution: | 1.Third Military Medical University,Chongqing,China;2.Department of Neurology,Military General Hospital of Beijing PLA,Beijing,China;3.Department of Radiology,Military General Hospital of Beijing PLA,Beijing,China;4.Neuroradiology Section, Department of Radiology,Stanford University,Stanford,USA;5.Wolfson Molecular Imaging Centre,University of Manchester,Manchester,UK;6.Department of Neurology, Southwest Hospital,Third Military Medical University,Chongqing,China;7.Department of Neurology, Changhai Hospital,Second Military Medical University,Shanghai,China;8.GE Healthcare,Beijing,China |
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Abstract: | In this study, we determined whether a prediction of final infarct volume (FIV) and clinical outcomes in patients with an acute stroke is improved by using a contrast transfer coefficient (K trans) as a biomarker for blood–brain barrier (BBB) dysfunction. Here, consecutive patients admitted with signs and symptoms suggesting acute hemispheric stroke were included in this study. Ninety-eight participants with intra-arterial therapy were assessed (46 female). Definition of predicted FIV was performed using conventional perfusion CT (PCT-PIV) parameters alone and in combination with K trans (K trans-PIV). Multiple logistic regression analyses and linear regression modeling were conducted to determine independent predictors of the 90-day modified Rankin score (mRS) and FIV, respectively. We found that patients with favorable outcomes were younger and had lower National Institutes of Health Stroke Scale (NIHSS) score, smaller PCT-PIV, K trans-PIV, and smaller FIV (P?<?0.001). K trans-PIV showed good correlation with FIV (P?<?00.001, R 2?=?0.6997). In the regression analyses, K trans-PIV was the best predictor of clinical outcomes (P?=?0.009, odds ratio (OR)?=?1.960) and also the best predictor for FIV (F?=?75.590, P?<?0.0001). In conclusion, combining PCT and K trans maps derived from first-pass PCT can identify at-risk cerebral ischemic tissue more precisely than perfusion parameters alone. This provides improved accuracy in predicting FIV and clinical outcomes. |
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