Untersuchungen zum prognostischen Wert der Ganzhirn-Volumen-Perfusions-CT bei Patienten mit akuter zerebraler Ischämie

Prognostic value of the whole-brain volume perfusion CT in acute stroke < 6 hours after symptom onset

by Sarah Finger
Doctoral thesis
Date of Examination:2016-11-03
Date of issue:2016-10-25
Advisor:Prof. Dr. Peter Schramm
Referee:Dr. Jan Liman
Referee:Prof. Dr. Thomas Meyer
Persistent Address: http://dx.doi.org/10.53846/goediss-5924

 

 

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Abstract

English

Background and Purpose: In the dissertation we examined the prognostic value of whole-brain volume perfusion computed tomography (VPCT) using a 128-slice multi-detector CT in patients with acute ischemic stroke within 6 hours of symptom onset. The hypothesis was tested that whole-brain VPCT applied to an acute stroke event shows a high prognostic value regarding the final extent of the stroke.  Methods: Analysis of 28 patients with an acute ischemic stroke who underwent non-contrast CCT, CT angiography and VPCT. The infarct volume on VPCT was compared to the infarct size on follow-up images (CT or MRI) performed within three days later (on average). For the subgroup analysis patients were dichotomised: Patients with a visable intracranial arterial vessel occlusion were distiguished from those not showing a vessel occlusion. Moreover patients were divided, depending on the severity of the symptoms, into groups with a NIHSS score of < 8 or ≥ 8.  The prognostic value was evaluated on the basis of the CT perfusion maps for time to peak (TTP), cerebral blood flow (CBF), cerebral blood volume (CBV) and cerebral blood volume using patlak analysis (CBV(P)). Furthermore the parameters tissue at risk (TAR) and non-viable tissue (NVT), defined by absolute threshold values, were evaluated. The evaluation of the CT perfusion maps was carried out after manually specifying the region of interest. The volumes determined in this way could hence be directly compared with the follow-up images.  Results: The extent of the ischemic lesion on the CT parameter maps of CBV and the combination of TAR and NVT resulted in the highest prognostic value. The division into subgroups did not have any influence on the statistical significance of the results.  Conclusion: Using VPCT (especially the CBV map) in acute stroke patients is suitable for rapid and accurate quantification of the final infarct volume. The CBV is therefore a prognostic parameter which should be evaluated in further studies to assess its impact on therapeutic decision.
Keywords: whole-brain perfusion ct; acute stroke; cerebral blood volume
Schlagwörter: Ganzhirn-Volumen-Perfusions-CT; akuter Schlaganfall; zerebrales Blutvolumen
 
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