Abstract
Background
Multimodal CT or MR imaging may be helpful in guiding reperfusion therapy for stroke.
However, access to multimodal imaging may frequently be limited. We hypothesised that
certain clinical and non-enhanced CT (NECT) findings at initial assessment can potentially
predict mismatch on CT perfusion (CTP) in patients with acute ischaemic stroke.
Methods
We undertook an analysis of prospectively collected clinical and imaging data of consecutive
patients with anterior circulation ischaemic stroke who underwent CTP during their
initial assessment. NECT was read for early ischaemic change as measured by the Alberta
Stroke Program Early CT Score (ASPECTS), and for hyperdense middle cerebral artery
sign (HMCAS). CTP images were evaluated for mismatch. Independent clinical and imaging
predictors of a CTP mismatch were identified using stepwise logistic regression.
Results
Of the 202 patients, 92 (46%) demonstrated a mismatch, 23 (11%) a matched deficit,
and 87 (43%) no perfusion deficit. HMCAS on NECT (OR 13.65, 95% CI 6.04–30.81, p < 0.001), female gender (OR 2.37, 95% CI 1.19–4.72, p = 0.015), atrial fibrillation (OR 2.05, 95% CI 1.02–4.11, p = 0.044), and absence of a history of hypertension (OR 0.46, 95% CI 0.22–0.96, p = 0.037) were independent predictors of a CTP mismatch. HMCAS had 58% sensitivity, 91%
specificity, 84% positive predictive value and 72% negative predictive value.
Conclusions
A HMCAS on the initial NECT is associated with a high probability of mismatch in acute
ischaemic stroke, and may identify patients most likely to benefit from recanalisation
treatments when access to multimodal CT or MR facilities is limited.
Keywords
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Article info
Publication history
Published online: August 26, 2013
Accepted:
July 8,
2013
Received in revised form:
July 3,
2013
Received:
March 31,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
