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(Radiology. 2001;219:95-100.)
© RSNA, 2001

Neuroradiology

Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT1

Rüdiger von Kummer, MD, Holger Bourquain, MD, Stefano Bastianello, MD, Luigi Bozzao, MD, Claude Manelfe, MD, Dieter Meier, MD, Werner Hacke, MD and For the European Cooperative Acute Stroke Study II Group.

1 From the Departments of Neuroradiology, University of Technology, Fetscherstrasse 74, D-01307 Dresden, Germany (R.v.K., H.B.); Università La Sapienza, Rome, Italy (S.B., L.B.); and University of Toulouse, France (C.M.); the Department of Neurology, University of Heidelberg, Germany (W.H.); and Boehringer-Ingelheim, Germany (D.M.). Received April 24, 2000; revision requested June 12; revision received July 17; accepted August 11. Address correspondence to R.v.K. (e-mail: kummer-r@rcs.urz.tu-dresden.de).

PURPOSE: To assess the capability of computed tomography (CT) in the prediction of irreversible ischemic brain damage and its association with the clinical course within 6 hours of stroke onset.

MATERIALS AND METHODS: Serial CT scans obtained within 6 hours of stroke onset, at 22–96 hours (median, 1 day), and at 2–36 days (median, 7 days) after symptom onset in 786 patients with ischemic stroke were prospectively studied, and follow-up CT scans were used as the reference. Clinical variables were assessed prospectively and independently of CT evaluation.

RESULTS: The specificity and positive predictive value of ischemic edema at baseline CT for brain infarcts were 85% (95% CI: 77%, 91%) and 96% (95% CI: 94%, 98%), respectively. Sensitivity and negative predictive values were 64% (95% CI: 60%, 67%) and 27% (95% CI: 23%, 32%), respectively. Patients without early CT findings were less severely affected (P < .001), developed smaller infarcts (P < .001), had fewer intracranial bleeding events (P < .001), and had a better clinical outcome at 90 days (P < .001) compared with patients with hypoattenuating brain tissue at early CT.

CONCLUSION: After ischemic stroke, x-ray hypoattenuation at CT is highly specific for irreversible ischemic brain damage if detection occurs within the first 6 hours. Patients without hypoattenuating brain tissue have a more favorable clinical course.

Index terms: Brain, CT, 10.12111 • Brain, infarction, 10.781 • Brain, ischemia, 10.781




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