BACKGROUND AND PURPOSE: Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome. METHODS:Fifty hyperacute CT scans (<6 hours after ictus) were selected from a randomized trial evaluating IV-tPA (ATLANTIS trial). Three neuroradiologists blinded to all clinical information evaluated scans for degree of MCA territory involvement (<33% or >33%) and the presence of a hyperdense MCA. Evaluations were compared with 24-hour scan results, 30-day infarct volumes, and baseline NIH stroke scale scores (NIHSS). RESULTS: Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlation=0.53, P<0.001), with all 3 readers agreeing in 36 of 50 cases (72%). They correctly called >33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when >33% MCA hypodensity was seen (P=0. 021). Detection of significant hypodensity (>33%) correlated with poorer outcome. When >33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm3, versus 84.3 to 123.1 cm3 when >33% hypodensity was present (P=0.002). CONCLUSIONS: Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction.
RCT Entities:
BACKGROUND AND PURPOSE: Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome. METHODS: Fifty hyperacute CT scans (<6 hours after ictus) were selected from a randomized trial evaluating IV-tPA (ATLANTIS trial). Three neuroradiologists blinded to all clinical information evaluated scans for degree of MCA territory involvement (<33% or >33%) and the presence of a hyperdense MCA. Evaluations were compared with 24-hour scan results, 30-day infarct volumes, and baseline NIH stroke scale scores (NIHSS). RESULTS: Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlation=0.53, P<0.001), with all 3 readers agreeing in 36 of 50 cases (72%). They correctly called >33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when >33% MCA hypodensity was seen (P=0. 021). Detection of significant hypodensity (>33%) correlated with poorer outcome. When >33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm3, versus 84.3 to 123.1 cm3 when >33% hypodensity was present (P=0.002). CONCLUSIONS: Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction.
Authors: J H Pexman; P A Barber; M D Hill; R J Sevick; A M Demchuk; M E Hudon; W Y Hu; A M Buchan Journal: AJNR Am J Neuroradiol Date: 2001-09 Impact factor: 3.825
Authors: J R Reichenbach; J Röther; L Jonetz-Mentzel; M Herzau; A Fiala; C Weiller; W A Kaiser Journal: AJNR Am J Neuroradiol Date: 1999 Nov-Dec Impact factor: 3.825
Authors: Edwin M Nemoto; Oscar Mendez; Mary E Kerr; Andrew Firlik; Kevin Stevenson; Tudor Jovin; Howard Yonas Journal: Transl Stroke Res Date: 2012-05-30 Impact factor: 6.829
Authors: V Mahajan; P T Minshew; J Khoury; P P Shu; M Muzaffar; T Abruzzo; J L Leach; T A Tomsick Journal: AJNR Am J Neuroradiol Date: 2008-03-20 Impact factor: 3.825
Authors: Chin A Yi; Dong Gyu Na; Jae Wook Ryoo; Chan Hong Moon; Hong Sik Byun; Hong Gee Roh; Won-Jin Moon; Kwang Ho Lee; Soo Joo Lee Journal: Korean J Radiol Date: 2002 Jul-Sep Impact factor: 3.500