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London, United Kingdom 2013 16 Brain imaging ABNORMAL CEREBRAL BLOOD VOLUM ON PERFUSION CT IS NOT A GOOD PRE-DICTOR OF FINAL INFARCT VOLUM IN ACUTE STROKE RECEIVING REPERFU-SION E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 237 THERAPY V. Obach1, L. Llull2, S. Rudiloso3, A. Lopez4, X. Urra5, S. Amaro6, L. San Roman7, A. Cervera8, A. Chamorro9 Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN1, Stroke Unit. Hospital Clinic Barce-lona, Barcelona, SPAIN2, Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN3, Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN4, Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN5, Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN6, Stroke Unit. Hospital Clinic Barcelona, Barcelona, SPAIN7, Stroke Unit. Hospital Clinic Barcelona, Barcelona, 8, Stroke Unit. Hospital Clinic Barcelona, Barcelona, 9 Background: Abnormal DWI areas on brain MR in acute stroke correlate with final cerebral infarct volume. The correlation of abnormal CBV on CT perfusion with non-viable tissue (NVT) in these patients is more controversial. We aim to evaluate if areas of NVT defined by abnormal CBV are finally not infarcted in patients re-ceiving reperfusion therapies. Methods: From March 2010 to February 2012, we identified 98 strokes in a prospective cohort of patients re-ceiving reperfusion therapy, having perfusion CT performed before reperfusion therapy or during iv tPA infusion and DWI brain MR done over 24h of treatment. Only 85 patients with large abnormal time to peak (TTP) lesion > 30ml were analyzed. NVT tissue was considered when CBV was un-der 1.6 ml/100g of tissue and was automatically calculated using Siemens Software. Final infarct volume was also automatically assessed on DWI images using AMIRA software. The percentage of non-infarcted areas (NIA) in areas of NVT on CBV maps was defined calculating abnormal volumes (DWI – CBV) / CBV. Arbitrarily, restrictive threshold of NIA>50% or less restrictive of NIA>20% were considered. Results: Baseline median NIHSS score was 14 (IQR 8-19). Overall, 74 (87%) patients received IV tPA and 52 (61%) intraarterial treatment (IAT). (41 rescue IAT). Successful recanalization (TICI 2b/3) was confirmed in 62/71 patients (87%). A percentage of NIA of > 50% was found in 36/85 patients (42.4%) and NIA of > 20% in 59/85 pa-tients. In patients with succefull recanalization, a percentage of NIA > 50% was observed in 30/62 (48%) compared with only 2/9 (22%) of patient with incomplete recanalization (p=0.17). When a propor-tion of NIA of >20% was considered, 41/62 (66%) patients with successful recanalization and 3/9 (33%) with incomplete recanalization were detected (p=0.07). Conclusions: Abnormal CBV on perfusion CT assessed in available automatic software is not a good marker of real non viable tissue in patients receiving reperfusion therapy. 15 Brain imaging Combining CT angiography with non-contrast CT to predict infarct on follow up CT in acute ischaemic stroke. Substudy analysis of imaging from the Third International Stroke Trial (IST-3) G. Mair1, J.M. Wardlaw2, P. Sandercock3, R. Lindley4, R. von Kummer5 The IST-3 Collaborative Group Western General Hospital, Edinburgh, UNITED KINGDOM1, University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3, Univer-sity of Sydney, Sydney, AUSTRALIA4, Dresden University Stroke Center, Dresden, GERMANY5 Background The Third International Stroke Trial (IST-3) is a multicentre, randomised controlled tri-al testing intravenous thrombolysis given within 6 hours of ischaemic stroke. Pre-randomisation and follow up brain imaging was performed for all patients and CT angiography (CTA) was additionally obtained in some centres. We aimed to identify whether CTA improved prediction of infarct on fol-low up CT over non-contrast CT alone. Methods We included IST-3 patients who had: pre-randomi-sation (PRCT) and follow up non-contrast CT (NCCT) and baseline CTA. A single observer (GM) analysed the images sequentially, blinded to subsequent imaging. We recorded the presence of isch-aemia (IST-3 score) and hyperattenuated arteries (HAS) on PRCT, and the presence of arterial ob-struction on CTA. We calculated the sensitivity and specificity of abnormal PRCT +/- CTA for pre-dicting infarction (IST-3 score) on follow-up CT and tested for significant differences. Results We included 234 patients (42% male, median age 81 years, IQR 71-86). PRCT was performed at medi-an 3.4 hours from stroke onset (IQR 2.3-4.8). Follow up NCCT was performed within 48 hours for 92%. PRCT was abnormal (acute ischaemia or HAS) in 37% (95%CI 31-43%). CTA was abnormal in 40% (95%CI 34-47%). Either PRCT or CTA were abnormal in 50% (95%CI 43-56%); both were abnormal in 27% (95%CI 22-33%). Sensitivity and specificity for infarct on follow-up CT were (respectively): of abnormal PRCT alone, 57% and 96%; of abnormal CTA alone, 55% and 91%; of both PRCT and CTA, 44% and 100% (compared with PRCT alone χ2 = 22, P<0.001); and of either PRCT or CTA, 71% and 87% (compared with PRCT alone χ2 = 27, P<0.001). Conclusion Combin-ing PRCT with CTA in acute stroke significantly increases sensitivity (if either NCCT or CTA are abnormal) or specificity (if both are abnormal) for predicting infarct on 48 hour follow up CT. The impact on clinical outcome and response to thrombolyic therapy will be reported in future analyses.


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