Perfusion CT and early thrombolytic therapy outcome: our experiences

Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compared to noncontrast CT (NCCT) in early diagnosis of acute ischemic stroke at University Hospital Split and to determine the value of these diagnostic procedures in assesment of adequate thrombolytic therapy. Methods and materials: 87 consecutive patients with acute ischaemic stroke within 3 hours of onset of symptoms underwent Stroke protocol that included NCCT, CTP and MSCTA (MSCT Sensation 16 Siemens, Germany). We used 200 ml of nonionic intravenous contrast media iopamidol 370 at an injection rate of 10, 0 ml/s. Patients with confirmed presence of an ischemic penumbra recieved thrombolytic therapy (Alteplase). Results: Ischemic stroke was confirmed in 78, 1% patients who were admitted with stroke symptoms to our emergency department. CTP was significantly superior to NCCT in depicting ischemic stroke (41 patients diagnosed with NCCT, in comparison to 68 with CTP, p= 0, 008). In 27 cases with negative NCCT there were signs of ischemic stroke on CTP, and 16 of patients with significant penumbra received thrombolytic therapy. NCCT sensitivity (taking CTP as the reference method) was 60, 3%. The accuracy of this method was 69%. Negative predictive value of NCCT in comparison to CTP was 41%. Conclusion: CTP is a sensitive tool for identifying early signs of ischemia and it should be done regulary in patients presenting with acute ischemic stroke symptoms. It is crucial in determining whether the thrombolysis is appropriate by estimating ischemic penumbra and infarct core.