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

Stroke. 1993 Sep;24(9):1322-9. doi: 10.1161/01.str.24.9.1322.

Abstract

Background and purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • 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
  • Middle Aged
  • National Institutes of Health (U.S.)
  • Tomography, Emission-Computed, Single-Photon*
  • United States