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AJNR - American Journal of Neuroradiology

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Prediction of Neurologic Deterioration in Patients with Lacunar Infarction in the Territory of the Lenticulostriate Artery Using Perfusion CT

Mikito Yamada^a,b, Shinichi Yoshimura^a, Yasuhiko Kaku^a, Toru Iwama^a, Hirotaka Watarai^b, Takashi Andoh^b and Noboru Sakai^a

^a Department of Neurosurgery, Division of Neuroscience, Gifu University School of Medicine, Gifu, Japan
^b Department of Neurosurgery, Murakami Memorial Hospital, Asahi University, Gifu, Japan

View larger version (94K): [in a new window]   FIG 1. Setting of regions of interest and representative images of CBF, CBV, and MTT. On the CBF map on perfusion CT scans, a round small region of interest was set at the region with decreased CBF in the territory of the lenticulostriate artery (region of interest 1 [ROI-1]). Another region of interest was set in the mirror position to region of interest 1 in the contralateral hemisphere (region of interest 2 [ROI-2]). Using these two regions of interest, CBF, CBV, and MTT were measured. MRI, MR image.

View larger version (36K): [in a new window]   FIG 2. Changes of infarction size on MR images (MRI). Infarction sizes were measured on initial FLAIR images and follow-up T2-weighted MR images. Significant difference was shown between the two groups in infarction size on follow-up MR images (P = .037) but not on initial MR images (P = .814). n.s., not significant.

View larger version (39K): [in a new window]   FIG 3. Comparison of CBF, CBV, and MTT in control and progress groups. Significant difference was shown in MTT value between the two groups (P < .001) but not in CBF value (P = .052) or CBV value (P = .349) in region of interest 1. Significant differences were shown between the two groups in CBF ratio (P = .016) and MTT ratio (P < .001) but not in CBV ratio (P = .695). n.s., not significant.

View larger version (21K): [in a new window]   FIG 4. Relationships between CBF and MTT ratio. With cutoff lines at <0.76 in the CBF ratio and at >1.26 in the MTT ratio, sensitivity was 76.3%, specificity was 92.3%, positive predictive value was 90.9%, and negative predictive value was 80.8%.