Computed Tomography Workup of Patients Suspected of Acute Ischemic Stroke

Abstract

However, there is no consensual agreement in the stroke community that perfusion/penumbral imaging is needed or even useful. There is still insufficient evidence that treat-ment decisions based on perfusion imaging improve clinical outcome in acute ischemic stroke patients, and the concept of penumbral image–guided thrombolytic therapy remains to be validated in a large phase III trial. 3,4 As a result, PCT has not become part of the clinical standard-of-care in reperfusion decisions. Several experts think that NCT and CTA combined with clinical information provide sufficient information about tissue fate and outcome. 5–9 The goal of our study was to determine whether PCT adds value to NCT, CTA, and clinical assessment in patients sus-pected of acute ischemic stroke in a large registry of stroke patients who were systematically imaged using NCT, PCT, and CTA. More specifically, we assessed (1) whether the infarct and penumbral information extracted from PCT can be inferred from NCT, CTA, and clinical characteristics, or whether it con-stitutes independent and unique information; and (2) whether PCT penumbral information is an independent predictor of clinical outcome measured as modified Rankin score (mRS) at 3 months, beside NCT, CTA, and clinical characteristics.