Abstract TP53: Simple And Easy Way Using Time-Intensity Curve of Perfusion-Weighted Images to Find Penumbra In Stroke Patients Within 4.5 Hours Of Onset Due To The Carotid Artery Occlusion

Abstract

[Purpose] It is not clear how to find penumbra from MR-PWI for reperfusion therapy (RT). The aim of our retrospective study was to investigate whether or not a simple way using time-intensity curve (TIC) of PWI can find penumbra in stroke patients admitted within 4.5 hours from sudden onset due to acute carotid artery occlusion. [Subjects and Methods] Included for analysis were stroke patients 1) who were admitted within 4.5 hours of onset between Jan 2006 and January 2011, 2) who presented NIHSS score of 6 or more on admission, and 3) who underwent emergency MR imaging , which suggested the affected carotid artery occlusion. We assessed, NIHSS on admission (NIH adm), DWI-ASPECT score, TIC types, successful recanalization (SR), NIHSS on the 7th day (NIH 7 th ), and in-hospital death. Early neurological improvement (ENI) was defined as NIH adm - NIH 7 th >0. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we classified TIC pattern into four types and defined type 1 as TPa>TPc and PSa<PSc/2, type2 as TPa>TPc and PSc/2≦PSa<PSc, type 3 as TPa >TPc and PSa≧PSc, and type 4 as TPa=TPc. Relationship between TIC types, in-hospital death and ENI were assessed. [Result] Eighty-seven patients were analyzed. There were 36, 39, 12 and 0 patients in TIC type 1, 2, 3 and 4, 39 patients (44.8%: 39/87) underwent RT and SR was achieved in 18 patients (46.2%), and 29 patients died. Among variables, TIC type 1 was the only determinant of in-hospital death (p<0.01) and SR coupled with TIC type 2 was the determinant of ENI (p<0.01). [Conclusion] TIC type 1 predetermines poor clinical outcome and type 2 means penumbra, where SR may early improve neurological symptoms. TIC is an easy way to find penumbra in an emergency setting.