CT Perfusion and Multiphase CT Angiography in Malignant Brain Edema Prediction in Patients with Acute Ischemic Stroke


Authors: O. Volný 1,2;  P. Cimflová 1,3;  C. D. D’esterre 4
Authors‘ workplace: ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 1;  I. neurologická klinika LF MU a FN u sv. Anny v Brně 2;  Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně 3;  Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada 4
Published in: Cesk Slov Neurol N 2016; 79/112(2): 213-217
Category: Short Communication
doi: 10.14735/amcsnn2016213

Podpořeno z Evropského regionálního rozvojového fondu –  Projekt FNUSA- ICRC (CZ.1.05/ 1.1.00/ 02.0123), Evropského sociálního fondu a státního rozpočtu České republiky.
Rádi bychom vyjádřili poděkování dr. Bijoy Menon MD MSc. (Hotchkiss Brain Institute, University of Calgary, Canada) a prof. Ting Lee PhD (Imaging Research Labs, Robarts Research Institute, Ontario, Canada) za poskytnutí přístupu k databázi pacientů, za cenné rady, vedení a pomoc při zpracování perfuzních dat, a doc. MU Dr. Robertovi Mikulíkovi, Ph.D., za cenné rady a odborné vedení.

Overview

We explore the predictive value of CT perfusion parameters (permeability surface area, cerebral blood flow, cerebral blood volume) and multiphase CT angiography (clot localization, leptomeningeal collaterals and dural sinuses morphology) in the development of malignant brain oedema in patients with acute proximal occlusion of the middle cerebral artery. Patients from the multicentre prospective study PROVE-IT (Precise and Rapid assessment of collaterals using multi-phase CTA in the triage of patients with acute ischemic stroke for IV or IA Therapy; n = 200) were analysed. Primary outcome was evaluated by midline shift ≥ 5 mm on a follow-up CT/MRI. A CBV threshold of 1.76 ml/100 g had the highest sensitivity and specificity of for the midline shift. There was no significant difference between the two groups in analysed CT perfusion parameters calculated for the entire ischemic region.

Key words:
acute ischemic stroke – brain oedema – CT perfusion – CTA angiography – dural sinuses

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Gupta R, Connolly ES, Mayer S, et al. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 2004;35(2):539– 43.

2. Cho DY, Chen TC, Lee HC. Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction. Surg Neurol 2003;60(3):227– 32.

3. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomized controlled trials. Lancet Neurol 2007;6(3):215– 22.

4. Bektas H, Wu TC, Kasam M, et al. Increased blood-brain barrier permeability on perfusion CT might predict 1. Stroke 2010;41(11):2539– 54. doi: 10.1161/ STROKEAHA.110.591362.

5. Hom J, Dankbaar JW, Soares BP, et al. Blood-brain barrier permeability assessed by perfusion CT predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. Am J Neuroradiol 2011;32(1):41– 8. doi: 10.3174/ ajnr.A2244.

6. Dittrich R, Kloska SP, Fischer T, et al. Accuracy of perfusion-CT in predicting malignant middle cerebral artery brain infarction. J Neurol 2008;255(6):896– 902. doi: 10.1007/ s00415-008-0802-1.

7. Dohmen C, Galldiks N, Bosche B, et al. The severity of ischemia determines and predicts malignant brain edema in patients with large middle cerebral artery infarction. Cerebrovasc Dis 2012;33(1):1– 7. doi: 10.1159/ 000330648.

8. Minnerup J, Wersching H, Ringelstein EB, et al. Prediction of malignant middle cerebral artery infarction using computed tomography-based intracranial volume reserve measurements. Stroke 2011;42(12):3403– 9. doi: 10.1161/ STROKEAHA.111.619734.

9. Menon BK, d’Esterre CD, Qazi EM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology 2015;275:510– 20. doi: 10.1148/ radiol.15142256.

10. Lawrence KS, Lee TY. An adiabatic approximation to the tissue homogeneity model for water exchange in the brain: II. experimental validation. J Cereb Blood Flow Metab 1998;18(12):1378– 85.

11. Nguyen GT, Coulthard A, Wong A, et al. Measurement of blood-brain barrier permeability in acute ischemic stroke using standard first-pass perfusion CT data. NeuroImage Clin 2013;2:658– 62. doi: 10.1016/ j.nicl.2013.04.004.

12. Elahy M, Jackaman C, Mamo JC, et al. Blood-brain barrier dysfunction developed during normal aging is associated with inflammation and loss of tight junctions but not with leukocyte recruitment. Immun Ageing 2015;12:2. doi: 10.1186/ s12979-015-0029-9.

13. Yu W, Rives J, Welch B, et al. Hypoplasia or occlusion of the ipsilateral cranial venous drainage is associated with early fatal edema of middle cerebral artery infarction. Stroke 2009;40(12):3736– 9. doi: 10.1161/ STROKEAHA.109.563080.

14. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372(24):2285– 95. doi: 10.1056/ NEJMoa1415061.

15. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372(11):1009– 18. doi: 10.1056/ NEJMoa1414792.

16. Powers WJ, Derdeyn CP, Biller J, et al. 2015 AHA/ ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke 2015;46(10):3020– 35. doi: 10.1161/ STR.0000000000000074.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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