Evaluation of Early Computed Tomographic Findings in Acute Ischemic Stroke

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Abstract
Background and Purpose —Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome. Methods —Fifty hyperacute CT scans (Results —Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlation=0.53, P 33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when >33% MCA hypodensity was seen ( P =0.021). Detection of significant hypodensity (>33%) correlated with poorer outcome. When >33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm 3 , versus 84.3 to 123.1 cm 3 when >33% hypodensity was present ( P =0.002). Conclusions —Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction.