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Comparative Study
. 2016 Dec;26(4):415-421.
doi: 10.1007/s00062-015-0375-1. Epub 2015 Feb 27.

Relation between stroke severity, patient characteristics and CT-perfusion derived blood-brain barrier permeability measurements in acute ischemic stroke

Alexander D Horsch  1   2 , Jan Willem Dankbaar  3 , Tom van Seeters  3 , Joris M Niesten  3 , Merel J A Luitse  4 , Pieter C Vos  3 , Irene C van der Schaaf  3 , Geert-Jan Biessels  4 , Yolanda van der Graaf  5 , L Jaap Kappelle  4 , Willem P Th M Mali  3 , Birgitta K Velthuis  3
Affiliations
Comparative Study

Relation between stroke severity, patient characteristics and CT-perfusion derived blood-brain barrier permeability measurements in acute ischemic stroke

Alexander D Horsch et al. Clin Neuroradiol. 2016 Dec.

Abstract

Purpose: Increased blood-brain barrier permeability (BBBP) can result from ischemia. In this study the relation between stroke severity, patient characteristics and admission BBBP values measured with CT-perfusion (CTP) was investigated in acute ischemic stroke patients.

Methods: From prospective data of the Dutch Acute Stroke Study 149 patients with a middle cerebral artery stroke and extended CTP were selected. BBBP values were measured in the penumbra and infarct core as defined by CTP thresholds, and in the contra-lateral hemisphere. The relation between stroke (severity) variables and patient characteristics, including early CT signs, dense vessel sign (DVS), time to scan and National Institute of Health Stroke Score (NIHSS), and BBBP parameters in penumbra and infarct core was quantified with regression analysis.

Results: Early CT signs were related to higher BBBP values in the infarct core (B = 0.710), higher ipsi- to contra-lateral BBBP ratios (B = 0.326) and higher extraction ratios in the infarct core (B = 16.938). Females were found to have lower BBBP values in penumbra and infarct core (B = - 0.446 and - 0.776 respectively) and lower extraction ratios in the infarct core (B = - 10.463). If a DVS was present the ipsi- to contra-lateral BBBP ratios were lower (B = - 0.304). There was no relation between NIHSS or time to scan and BBBP values.

Conclusion: Early CT signs are related to higher BBBP values in the infarct core, suggesting that only severe ischemic damage alters BBBP within the first hours after symptom onset.

Keywords: Acute ischemic stroke; Blood-brain barrier permeability; CT perfusion; Dense vessel sign; Early CT signs.

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Figures

Fig. 1
Fig. 1
Drawing of ROIs in infarct core and penumbra
See this image and copyright information in PMC

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