RT Journal Article
SR Electronic
T1 Quantification of Thrombus Hounsfield Units on Noncontrast CT Predicts Stroke Subtype and Early Recanalization after Intravenous Recombinant Tissue Plasminogen Activator
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 90
OP 96
DO 10.3174/ajnr.A2878
VO 33
IS 1
A1 J. Puig
A1 S. Pedraza
A1 A. Demchuk
A1 J. Daunis-i-Estadella
A1 H. Termes
A1 G. Blasco
A1 G. Soria
A1 I. Boada
A1 S. Remollo
A1 J. Baños
A1 J. Serena
A1 M. Castellanos
YR 2012
UL http://www.ajnr.org/content/33/1/90.abstract
AB BACKGROUND AND PURPOSE: Little is known about the factors that determine recanalization after intravenous thrombolysis. We assessed the value of thrombus Hounsfield unit quantification as a predictive marker of stroke subtype and MCA recanalization after intravenous rtPA treatment. MATERIALS AND METHODS: NCCT scans and CTA were performed on patients with MCA acute stroke within 4.5 hours of symptom onset. Demographics, stroke severity, vessel hyperattenuation, occlusion site, thrombus length, and time to thrombolysis were recorded. Stroke origin was categorized as LAA, cardioembolic, or indeterminate according to TOAST criteria. Two blinded neuroradiologists calculated the Hounsfield unit values for the thrombus and contralateral MCA segment. We used ROC curves to determine the rHU cutoff point to discriminate patients with successful recanalization from those without. We assessed the accuracy (sensitivity, specificity, and positive and negative predictive values) of rHU in the prediction of recanalization. RESULTS: Of 87 consecutive patients, 45 received intravenous rtPA and only 15 (33.3%) patients had acute recanalization. rHU values and stroke mechanism were the highest predictive factors of recanalization. The Matthews correlation coefficient was highest for rHU (0.901). The sensitivity, specificity, and positive and negative predictive values for lack of recanalization after intravenous rtPA for rHU ≤ 1.382 were 100%, 86.67%, 93.75%, and 100%, respectively. LAA thrombi had lower rHU than cardioembolic and indeterminate stroke thrombi (P = .004). CONCLUSIONS: The Hounsfield unit thrombus measurement ratio can predict recanalization with intravenous rtPA and may have clinical utility for endovascular treatment decision making. ASPECTSAlberta Stroke Program Early CT ScoreDIASDesmoteplase in Acute Ischemic StrokeDICOMdigital imaging and communication in medicineHMCAShyperdense middle cerebral artery signICCintraclass correlation coefficientIQRinterquartile rangeLAAlarge artery atherosclerosisMIPmaximum intensity projectionmRSmodified Rankin ScaleNINDSNational Institute of Neurological Disorders and StrokerHUHounsfield Unit ratiorϕMatthews correlation coefficientROCreceiver operating characteristicrt-PArecombinant tissue plasminogen activatorTIBIThrombolysis in Brain IschemiaTIMIThrombolysis in Myocardial InfarctionTOASTTrial of Org 10172 in Acute Stroke Treatment