London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 405 226 Brain imaging Association of non-contrast CT and CT angiography with baseline clinical deficit and func-tional outcome. Substudy analysis of imaging from the Third International Stroke Trial (IST- 3) G. Mair1, J.M. Wardlaw2, P. Sandercock3, R. Lindley4, R. von Kummer5, A.J. Farrall6 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, University of Edinburgh, Edinburgh, UNITED KINGDOM6 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 acute clinical deficit and late functional outcome over non-contrast CT alone. Methods We included IST-3 patients who had: pre-randomisation (PRCT) and follow up non-contrast CT (NCCT) and baseline CTA. A single observer (GM) analysed the images sequentially, blinded to subsequent imaging and clinical findings. We recorded the presence of ischaemia (IST-3 score) and hyperattenuated arteries (HAS) on PRCT, and the presence of arterial obstruction on CTA. We compared abnormal PRCT (acute ischaemia or HAS) with abnormal PRCT +/- abnormal CTA for baseline stroke severity (National Institutes of Health Stroke Scale – NIHSS) and disability or death on Oxford Handicap Scale (OHS 3-6) at 6 months. Results We included 234 patients (42% male, median age 81 years, IQR 71-86). PRCT was performed at median 3.4 hours from stroke onset (IQR 2.3-4.8). Follow up NCCT was performed within 48 hours for 92%. Abnormality was present on PRCT in 37% (95%CI 31-43%), CTA in 40% (95%CI 34-47%), and on PRCT or CTA in 50% (95%CI 43-56%). Abnormal vs nor-mal PRCT predicted worse NIHSS (16 vs 8, p<0.001) and worse OHS 3-6 (74 vs 45%, χ2 = 20, p<0.001). Having either PRCT or CTA abnormal provided very similar results; worse NIHSS (16 vs 7, p<0.001) and worse OHS 3-6 (73 vs 38%, χ2 = 29, p<0.001). Neither NIHSS nor rate of OHS 3-6 were significantly different between the abnormal PRCT and abnormal PRCT with CTA groups (p=1.000). Conclusion Including CTA in the imaging assessment of acute stroke identifies more pa-tients with abnormal scans but this information does not alter the prediction of NIHSS or 6 month functional outcome. 227 Brain imaging The lacunar perfusion deficit M.E. Wolf1, M. Griebe2, M. Kablau3, E. Fischer4, A. Gass5, M.G, Hennerici6, R. Kern7, K. Szabo8 Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mann-heim, GERMANY1, Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY2, Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY3, Department of Neurology, UniversitaetsMediz-in Mannheim, University of Heidelberg, Mannheim, GERMANY4, Department of Neurology, Uni-versitaetsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY5, Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY6, Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY7, Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidel-berg, Mannheim, GERMANY8 Background: Lacunar stroke is a common stroke aetiology accounting for about 20% of all ischemic strokes. However, knowledge about the perfusion status in lacunar stroke demonstrated by magnetic resonance (MR) perfusion imaging is scarce. Methods: From a prospectively collected stroke database, we identified patients with acute lacunar stroke defined by typical lesion pattern on diffusion-weighted imaging (DWI) and a comprehen-sive stroke work-up excluding all cases with possible concurrent aetiologies (ASCO classifica-tion). Clinical data of 86 subjects including NIHSS score and modified Rankin scale score (mRS) at discharge and at 3 months were collected. A standardized MR imaging protocol including DWI, FLAIR- and dynamic susceptibility contrast-enhanced perfusion imaging (PWI) was performed. PWI studies were classified as (i) normal or as (ii) hypoperfusion corresponding to the localization of the ischemic area. Results: The mean age of the collective was 66 years (33 women) presenting with initial median NIHSS score of 4 (range 0-16). The median mRS at discharge was 2 (range 0-5) and improved to 1 (range 0-4) at 3 months. In 28 patients (33%) PWI was normal; in 49 patients (57%) a hypoper-fusion on PWI was detected in the corresponding acute ischemic area (see Figure for example of striatolenticular and thalamic stroke). In 9 patients PWI could not be interpreted due to poor image quality. The median mRS at 3 months was 0 in the subgroup with normal perfusion and 2 in the sub-group with hypoperfusion, respectively. Conclusion: Although the lesion size in lacunar stroke is typically small, a perfusion deficit could be detected by PWI in a large number of patients, indicating that even small perfusion abnormalities can be identified with MRI. The extent of perfusion abnormalities assessed by MRI might have an impact on the early course and further outcome of lacunar stroke.
Karger_ESC London_2013
To see the actual publication please follow the link above