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BACKGROUND AND PURPOSE-We investigated whether computed tomography(CT)perfusion-derived cerebral blood flow(CBF)and cerebral blood volume(CBV)could be used to differentiate between penumbra and infarcted gray matter in a limited,exploratory sample of acute stroke patients.METHODS-Thirty patients underwent a noncontrast CT(NCCT),CT angiography(CTA),and CT perfusion(CTP)scan within 7 hours of stroke onset,NCCT and CTA at 24 hours,and NCCT at 5 to 7 days.Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups:those with recanalization at 24 hours(n=16)and those without(n=9).Penumbra was operationally defined as tissue with an admission CBF < 25mL·100g·min that was not infarcted on the 5-to 7-day NCCT.Logistic regression was applied to differentiate between infarct and penumbra data points.RESULTS-For recanalized patients,CBF was significantly lower(P < 0.05)for infarct(13.3±3.75mL·100 g·min)than penumbra(25.0±3.82mL·100 g·min).CBV in the penumbra(2.15±0.43 mL·100 g)was significantly higher than contralateral(1.78±0.30 mL·100 g)and infarcted tissue(1.12±0.37 mL·100 g).Logistic regression using an interaction term(CBF×CBV)resulted in sensitivity,specificity,and accuracy of 97.0%,97.2%,and 97.1%,respectively.The interaction term resulted in a significantly better(P < 0.05)fit than CBF or CBV alone,suggesting that the CBV threshold for infarction varies with CBF.For patients without recanalization,CBF and CBV for infarcted regions were 15.1±5.67 mL·100 g·min and 1.17±0.41 mL·100 g,respectively.CONCLUSIONS-We have shown in a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.
BACKGROUND AND PURPOSE-We asked whether computed tomography (CT) perfusion-derived cerebral blood flow (CBF) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients. METHODS-Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days.Twenty-five patients met the criteria for inclusion and were divided divided into 2 groups: those with recanalization at 24 hours (n = 16) and those without (n = 9) .Penumbra was operationally defined as tissue with an admission CBF <25 mL · 100 g · min that was not infarcted on the 5-to 7-day NCCT. Logistic regression was applied to differentiate between infarct and penumbra data points .RESULTS-For recanalized patients, CBF was significantly lower (P <0.05) for infarct (13.3 ± 3.75 mL · 100 g · min) than penumbra (25.0 ± 3.82 mL · 100 g · min) .CBV in the pen Logistic regression using an interaction term (CBF × CBV) resulted in (2.15 ± 0.43 mL · 100 g) was significantly higher than contralateral (1.78 ± 0.30 mL · 100 g) and infarcted tissue (1.12 ± 0.37 mL · 100 g) sensitivity, specificity, and accuracy of 97.0%, 97.2%, and 97.1%, respectively. The interaction term resulted in a significantly better (P <0.05) fit than CBF or CBV alone, suggesting that the CBV threshold for infarction varies with CBF. For patients without recanalization, CBF and CBV for infarcted regions were 15.1 ± 5.67 mL · 100 g · min and 1.17 ± 0.41 mL · 100 g, respectively. CONCLUSIONS-We have shown a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.