Value of single-photon emission-computed tomography in acute stroke therapeutic trials

• Published in: Stroke (1970) Vol. 24; no. 9; pp. 1322 - 1329
• Main Authors: HANSON, S. K, GROTTA, J. C, RHOADES, H, TRAN, H. D, LAMKI, L. M, BARRON, B. J, TAYLOR, W. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.09.1993
• Subjects: Acute Disease; Aged; Aged, 80 and over; Biological and medical sciences; Brain Edema - etiology; Cerebral Hemorrhage - etiology; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - therapy; Female; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - diagnostic imaging; Male; Medical sciences; Middle Aged; National Institutes of Health (U.S.); Neurology; Tomography, Emission-Computed, Single-Photon; United States; Vascular diseases and vascular malformations of the nervous system; Radionuclide study; Human; Nervous system diseases; Stroke; Prognosis; Acute; Cardiovascular disease; Photon; Cerebral disorder; Vascular disease; Ischemia; Classification; Severity score; Positron emission tomography; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.24.9.1322

New therapeutic interventions for acute ischemic stroke are aimed at improving cerebral blood flow in the first 3 to 6 hours after symptom onset. Single-photon emission-computed tomography (SPECT) performed in the setting of clinical therapeutic trials may give us a better understanding of the physiological response to new forms of treatment and could impact acute management decisions. We prospectively studied 15 patients with hemispheric ischemic stroke with SPECT within 6 hours of symptom onset and again at 24 hours. The ischemic defect was assessed in a semiquantitative manner that used computer-generated regions of interest (SPECT graded scale). This measure was correlated with clinical presentation (National Institutes of Health [NIH] Stroke Scale), initial clinical course (change in NIH Stroke Scale), long-term outcome (Barthel Index at 3 months), and complications of cerebral hemorrhage and edema. The severity of the SPECT graded scale on the admission scan correlated with the severity of neurological deficit (admission NIH Stroke Scale) (P < .05) and was positively associated with poor long-term outcome as measured with the Barthel Index (P < .001) and the complications of cerebral hemorrhage and massive cerebral edema (P < .005). In fact, there was a threshold value for the SPECT graded scale above which all patients suffered poor long-term outcome and the complications of cerebral hemorrhage and edema. The measurement of an ischemic defect using SPECT is a valid assessment of hemispheric stroke severity in the hyperacute setting and may be useful for selecting or stratifying patients in clinical therapeutic trials.