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CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy

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Abstract

In this study, we determined whether a prediction of final infarct volume (FIV) and clinical outcomes in patients with an acute stroke is improved by using a contrast transfer coefficient (K trans) as a biomarker for blood–brain barrier (BBB) dysfunction. Here, consecutive patients admitted with signs and symptoms suggesting acute hemispheric stroke were included in this study. Ninety-eight participants with intra-arterial therapy were assessed (46 female). Definition of predicted FIV was performed using conventional perfusion CT (PCT-PIV) parameters alone and in combination with K trans (K trans-PIV). Multiple logistic regression analyses and linear regression modeling were conducted to determine independent predictors of the 90-day modified Rankin score (mRS) and FIV, respectively. We found that patients with favorable outcomes were younger and had lower National Institutes of Health Stroke Scale (NIHSS) score, smaller PCT-PIV, K trans-PIV, and smaller FIV (P < 0.001). K trans-PIV showed good correlation with FIV (P < 00.001, R 2 = 0.6997). In the regression analyses, K trans-PIV was the best predictor of clinical outcomes (P = 0.009, odds ratio (OR) = 1.960) and also the best predictor for FIV (F = 75.590, P < 0.0001). In conclusion, combining PCT and K trans maps derived from first-pass PCT can identify at-risk cerebral ischemic tissue more precisely than perfusion parameters alone. This provides improved accuracy in predicting FIV and clinical outcomes.

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Acknowledgments

We would like to thank Statistical Elite Studios [www.tjstat.com/] for helping with statistical analyses. This study was supported by the National Natural Science Foundations of China (Grant No. 81371286 and No. 81501024), Clinical Innovation Foundation of Southwest Hospital (Grant No. SWH2013LC20), Innovation and Development Foundation of Military General Hospital of Beijing PLA (Grant No. 2015-LC-01), and Clinical Innovation Foundation of Southwest Hospital (Grant No. SWH2013LC20).

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    Authors and Affiliations

    1. Third Military Medical University, Chongqing, 400038, China

      Nan Liu

    2. Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China

      Nan Liu, Hui Chen, Ying Li, Guangming Zhu & Weiwei Zhang

    3. Department of Radiology, Military General Hospital of Beijing PLA, Beijing, 100700, China

      Bing Wu

    4. Neuroradiology Section, Department of Radiology, Stanford University, Stanford, CA, USA

      Max Wintermark

    5. Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK

      Alan Jackson

    6. Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

      Jun Hu

    7. Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China

      Yongwei Zhang

    8. GE Healthcare, Beijing, China

      Zihua Su

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    1. Nan Liu
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    Correspondence to Guangming Zhu or Weiwei Zhang.

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    Ethical approval (No. 2013008) was obtained from the Institutional Ethics Committee at the Ethics Committee of Military General Hospital of Beijing PLA. Patients enrolled in this study signed written informed consent. All procedures were subjected to the Declaration of Helsinki.

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    Nan Liu and Hui Chen contributed equally to this work.

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    Liu, N., Chen, H., Wu, B. et al. CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy. Mol Neurobiol 54, 2539–2546 (2017). https://doi.org/10.1007/s12035-016-9838-x

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    • DOI: https://doi.org/10.1007/s12035-016-9838-x

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