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Predicting the Fate of Acute Ischemic Lesions Using Perfusion Computed Tomography

Hagiwara, Hiroshi MD*; Nakamura, Hidenori MD*; Igarashi, Hironaka MD; Katayama, Yasuo MD*

Journal of Computer Assisted Tomography: July-August 2008 - Volume 32 - Issue 4 - p 645-650
doi: 10.1097/RCT.0b013e31813fcff7
Neuroimaging: Original Article

Objective: To investigate whether the prognosis of ischemic tissues in acute cerebral ischemia can be predicted using perfusion computed tomography-derived parameters and, if so, which are the most useful.

Methods: Perfusion computed tomography was performed on 13 ischemic stroke patients within 6 hours of ischemic onset. The absolute and normalized values of regional cerebral blood flow (rCBF), regional cerebral blood volume, and regional mean transit time (rMTT) and their mirror regions were divided into those that infarcted or survived. Receiver operating characteristic analysis was subsequently conducted for these 3 parameters, and their relationship to the threshold and predictability of infarction were evaluated.

Results: Acute ischemic lesions with less than 63% of normal rCBF or more than 220% of rMTT almost invariably led to infarction; moreover, the receiver operating characteristic analysis revealed that both rMTT and rCBF, and their normalized derivatives, were equally predictive of infarction.

Conclusion: Both rCBF and rMTT can be used to predict the ultimate pathological prognosis of cerebral ischemia. Perfusion computed tomography is a very useful early-stage tool for the assessment of these patients.

From the *Division of Neurology, Nephrology and Rheumatology, Internal Medicine, Nippon Medical School, Tokyo; and †Center for Integrated Human Brain Science, Brain Research Institute, University of Niigata, Niigata, Japan.

Received for publication March 28, 2007; accepted June 12, 2007.

Reprints: Hiroshi Hagiwara, Division of Neurology, Nephrology and Rheumatology, Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8605, Japan (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.