TY - JOUR
T1 - Early prediction of irreversible brain damage after ischemic stroke at CT
AU - Von Kummer, R.
AU - Bourquain, H.
AU - Bastianello, S.
AU - Bozzao, L.
AU - Manelfe, C.
AU - Meier, D.
AU - Hacke, W.
PY - 2001
Y1 - 2001
N2 - PURPOSE: To assess the capability of computed tomography (CT) in the prediction of irreversible ischemic brain damage and its association with the clinical course within 6 hours of stroke onset. MATERIALS AND METHODS: Serial CT scans obtained within 6 hours of stroke onset, at 22-96 hours (median, 1 day), and at 2-36 days (median, 7 days) after symptom onset in 786 patients with ischemic stroke were prospectively studied, and follow-up CT scans were used as the reference. Clinical variables were assessed prospectively and independently of CT evaluation. RESULTS: The specificity and positive predictive value of ischemic edema at baseline CT for brain infarcts were 85% (95% Cl: 77%, 91%) and 96% (95% Cl: 94%, 98%), respectively. Sensitivity and negative predictive values were 64% (95% Cl: 60%, 67%) and 27% (95% Cl: 23%, 32%), respectively. Patients without early CT findings were less severely affected (P <.001), developed smaller infarcts (P <.001), had fewer intracranial bleeding events (P <.001), and had a better clinical outcome at 90 days (P <.001) compared with patients with hypoattenuating brain tissue at early CT. CONCLUSION: After ischemic stroke, x-ray hypoattenuation at CT is highly specific for irreversible ischemic brain damage if detection occurs within the first 6 hours. Patients without hypoattenuating brain tissue have a more favorable clinical course.
AB - PURPOSE: To assess the capability of computed tomography (CT) in the prediction of irreversible ischemic brain damage and its association with the clinical course within 6 hours of stroke onset. MATERIALS AND METHODS: Serial CT scans obtained within 6 hours of stroke onset, at 22-96 hours (median, 1 day), and at 2-36 days (median, 7 days) after symptom onset in 786 patients with ischemic stroke were prospectively studied, and follow-up CT scans were used as the reference. Clinical variables were assessed prospectively and independently of CT evaluation. RESULTS: The specificity and positive predictive value of ischemic edema at baseline CT for brain infarcts were 85% (95% Cl: 77%, 91%) and 96% (95% Cl: 94%, 98%), respectively. Sensitivity and negative predictive values were 64% (95% Cl: 60%, 67%) and 27% (95% Cl: 23%, 32%), respectively. Patients without early CT findings were less severely affected (P <.001), developed smaller infarcts (P <.001), had fewer intracranial bleeding events (P <.001), and had a better clinical outcome at 90 days (P <.001) compared with patients with hypoattenuating brain tissue at early CT. CONCLUSION: After ischemic stroke, x-ray hypoattenuation at CT is highly specific for irreversible ischemic brain damage if detection occurs within the first 6 hours. Patients without hypoattenuating brain tissue have a more favorable clinical course.
KW - Brain, CT
KW - Brain, infarction
KW - Brain, ischemia
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M3 - Article
C2 - 11274542
AN - SCOPUS:0035080012
VL - 219
SP - 95
EP - 100
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 1
ER -