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| Relationship of CT findings to lesion extent determined |
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28 February 2006
German study results suggest that oedema seen in acute stroke patients on cerebral computed tomography (CT) is related to the size of the infarct core, but underestimates the extent of penumbral hypoperfusion.
Although CT is the "working horse" of acute stroke diagnosis, the researchers, from the University of Cologne, point out that uncertainties remain regarding the application of early CT findings to therapeutic decisions such as treatment with thrombolysis.
The team, led by Dr Jan Sobesky, therefore compared the extent of oedema on CT in stroke patients within 6 hours of symptom onset with the lesion size on diffusion-weighted magnetic resonance imaging (DWI) and the cerebral blood flow (CBF) measured using positron emission tomography (PET). Overall, oedema volume significantly correlated with DWI lesion size, with the median DWI value being 115.9% of the median CT oedema volume of 15.8mL. In three of 11 patients, CT-defined oedema was equivalent to the DWI lesion volume, while four patients had smaller DWI lesions and four had larger infarct areas than that indicated by CT findings. In contrast, oedema volume was not predictive of the extent of penumbral hypoperfusion suggested by PET measurement of CBF, with this being overestimated in one patient, and underestimated in the other 10 individuals.
"Our observations support the hypothesis that CT is specific in detecting ischemic damage, but insensitive in detecting hypoperfusion of a lesser degree not causing irreversible injury," the investigators conclude in the journal Cerebrovascular Diseases.
Reference:
Cerebrovasc Dis 2006; 21 (5-6): 336-339.
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