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AJNR - American Journal of Neuroradiology

Published ahead of print on October 5, 2007
doi: 10.3174/ajnr.A0689

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Alberta Stroke Program Early CT Scoring of CT Perfusion in Early Stroke Visualization and Assessment

R.I. Aviv^a, J. Mandelcorn^a, S. Chakraborty^a, D. Gladstone^b, S. Malham^a, G. Tomlinson^c, A.J. Fox^a and S. Symons^a

^a Division of Neuroradiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
^b Division of Neurology and Regional Stroke Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
^c Department of Biostatistics, University of Toronto, Toronto, Ontario, Canada

View larger version (98K): [in this window] [in a new window]   Fig 1. A 75-year-old man, within 2 hours of right-sided stroke and presentation of NIHSS 20. A, NCCT demonstrates subtle loss of the left posterior putamen, internal capsule, and posterior insular cortex (white arrowhead) (ASPECTS 7). B, Cerebral blood flow. C, Cerebral blood volume. D, Mean transit time. Cerebral blood volume demonstrates an abnormality confined to the posterior putamen and internal capsule (ASPECTS 8), with larger cerebral blood flow and mean-transit-time abnormalities corresponding to the left middle cerebral artery M1 segment occlusion (not shown). E, Follow-up NCCT at day 6 shows an indistinct posterior putamen confirmed on diffusion-weighted MR imaging (F). The patient recovered by 18 points with a final NIHSS of 2.

View larger version (15K): [in this window] [in a new window]   Fig 2. A plot of mean baseline ASPECTS NCCT, cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) against major neurologic improvement, demonstrating that only CBV is predictive of 24-hour NIHSS change.

View larger version (12K): [in this window] [in a new window]   Fig 3. A plot of mean baseline ASPECTS NCCT, cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT). Results are dichotomized for clinical outcome by using 2-sample t tests. Favorable outcome was defined as mRS 2. Comparison of mean clinical outcomes was based on dichotomized mRS (0–2 versus 3–6), by using unequal variance 2-sample t tests.