Comparison of perfusion computed tomography with diffusion-weighted magnetic resonance imaging in hyperacute ischemic stroke

Objective: In this study, perfusion CT and diffusion-weighted magnetic resonance imaging (DWI) were compared as means of assessing the ischemic brain in hyperacute stroke. Methods: Twenty patients with ischemic stroke underwent perfusion computed tomography (CT) and magnetic resonance imaging (MRI) studies <3 hours after stroke onset. Cerebral blood flow thresholds were used to delineate the ischemic lesion, penumbra, and infarct. Correlations between the volume of the hypoperfused areas, the abnormality volume in admission DWI and follow-up CT/MRI studies, and the clinical National Institutes of Health Stroke Scale (NIHSS) scores were performed. Results: The volume of the ischemic (core and penumbra) lesion on admission perfusion CT was correlated with the volume of admission DWI abnormalities (r = 0.89, P = 0.001). The infarcted core tissue volume (on admission CT) correlated more strongly (r(2) = 0.77, P = 0.0001) than the admission DWI abnormality volume (r(2) = 0.69, P = 0.002) with the follow-up infarct volume on fluid-attenuated inversion recovery images. A correlation was demonstrated between infarct volume in perfusion CT and follow-up DWI abnormality volume (r = 0.89, r 2 = 0.77, P = 0.002). Significant correlations were found between ischemic and infarct region volumes in perfusion CT and NIHSS admission and follow-up scores (P less than or equal to 0.01). Conclusions: Both imaging modalities provide a sufficient assessment of the hyperacute brain infarct, with significant correlation between them and the clinical condition at admission. Perfusion CT allows differentiation of the penumbra and infarct core region with significant predictive value of follow-up infarct volume and clinical outcome.