Clinical Usefulness of Perfusion CT in Acute Ischemic Stroke

Background : In recent years, thrombolytic therapy has been used with success to reduce the infarction area in patients with acute cerebral infarction, It is very important to identify ischemic penumbra in the treatment of stroke. The aim of this study is detect ischemic penumbra and border between ischemic penumbra and infarction area using perfusion CT and diffusion-weighted MR images (DW-MRI) in patient's with acute ischemic stroke. Methods : Thirteen inpatients with acute ischemic stroke at the Department of Neurology at Chonnam University Hospital were selected for this study. They had the discrepancy of lesion between perfusion CT and DW-MRI. Perfusion CT was done on admission and DW-MRI within 24 hours after stroke in all patients. Ischemic penumbra was assessed by comparing the defect on perfusion CT with the infarction area on DW-MRI. Clinical outcome was measured with the NIHSS on day 1, 3, and 7. Results : The subjects (perfusion defect on the perfusion CT> infarction area on DW-MRI) achieved significant improvement at NIHSS. There was a significant difference between infarct and non-infarct tissue for both rCBF and rCBV but not for MTT. It could be possible not to define the tissue outcome but to estimate it by this study. Conclusions : Perfusion CT with DW-MRI is a useful tool for the detection of ischemic penumbra which may be the main target of active treatment.