THE PREDICTIVE VALUE OF EARLY CT FINDINGS FOR SUBSEQUENT CEREBRAL INFARCTION IN HYPERACUTE ISCHEMIC STROKE
Abstract
PURPOSE: To evaluate the relationship and the prediction of early CT signs of ischemic stroke and the location of subsequent infarction.
METHOD: We prospectively evaluated cranial CT signs of 75 consecutive patients with hyperacute ischemic stroke (within 6 hours of ictus) in the territory of the middle cerebral artery with evaluated at least 2 CTs (1 initial, within first 6 hours and 1 repeated CT within 48-72 hours of onset to confirm the infarct location) by one radiologist. On the first CT, early signs were hyperdenseMCA sign (HMCAS), early parenchymatous signs (attenuation of the lentiform nucleus [ALN], loss of the insular ribbon {LIR]), and early cortical edema are hemispheric sulcal effacement [HSE] and cortical hypodensity. Subsequent infarct locations were classified according to total, partial superficial, deep, or multiple MCA territories.
RESULT: Early CT abnormalities were found in 42 patients (56%). Isolated sign (HMCAS, isolated ALN and isolated LIR) 6 patients (14%), two signs (ALN/LIR) 7 patients (16%) and more than two signs 29 patients (70%). We found isolated HMCAS, two parenchymatous signs (ALN/LIR) and one or both parenchymatous signs (ALN or LIR) with cortical edema (HSE /cortical hypodensity) were strongly associated with subsequent large infarction and the positive predictive value of these signs for subsequent large infarctions were 100%, 85.7% and 86% respectively. The positive predictive value of isolated parenchymatous sign (isolated ALN or LIR) for deep infarction was 100% but the positive predictive value of negative early CT signs and isolated parenchymatous sign for subsequent large infarction were 0% and negative predictive value of these signs were 75% and 86.5% respectively.
CONCLUSION: Our findings suggested that positive early CT signs in first 6 hours allow the prediction of subsequent infarct locations. Early parencymatous signs associated with early cortical edema are strongly associated with subsequent large infarction but negative early CT signs and isolated parenchymatous sign are associated with subsequent deep infarction.
MCA = Middle Cerebral Artery
HMCAS = Hyperdense MCA sign.
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