Description:
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<jats:italic>Background and Purpose</jats:italic>
—We sought to study the prognostic value of early
<jats:sup>99m</jats:sup>
technetium–ethyl-cysteinate-dimer single-photon emission CT (
<jats:sup>99m</jats:sup>
Tc-ECD SPECT) for fatal ischemic brain edema in patients with middle cerebral artery (MCA) stroke compared with the prognostic value of CT and of clinical findings.
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<jats:italic>Methods</jats:italic>
—We prospectively studied 108 patients clinically, with
<jats:sup>99m</jats:sup>
Tc-ECD SPECT, and with CT within 6 hours of symptom onset (Scandinavian Stroke Scale <40 points) appropriate to MCA ischemia. The follow-up consisted of Scandinavian Stroke Scale and CT on days 1 and 7, Barthel Index, and Modified Rankin Scale after 3 months. An activity deficit of the complete MCA territory on the SPECT scans and a parenchymal hypoattenuation of the complete MCA territory on CT scans were considered as predictors for a fatal MCA infarction due to mass effect and midbrain herniation.
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<jats:italic>Results</jats:italic>
—In 11 of 108 patients (10%), the MCA infarction was the cause of death. The sensitivity of SPECT for fatal outcome was 82% in both visual and semiquantitative analyses, while specificity was 98% and 99%, respectively. The sensitivity and specificity of baseline CT were 36% and 100%, respectively; the sensitivity and specificity of clinical findings (Scandinavian Stroke Scale, depressed level of consciousness, gaze deviation) varied from 36% to 73% and from 45% to 88%, respectively. In a multivariate logistic regression model, only SPECT findings were found to be independent predictors of malignant MCA infarction/death.
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<jats:italic>Conclusions</jats:italic>
—We were able to identify patients with fatal MCA infarction with high accuracy by using
<jats:sup>99m</jats:sup>
Tc-ECD SPECT within 6 hours of stroke onset. This technique offers great potential to select stroke patients for specific therapies, eg, decompressive hemicraniectomy, soon after onset of symptoms.
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