Simple visual analysis of brain perfusion on HMPAO SPECT predicts early outcome in acute stroke

Background and Purpose Single-photon emission computed tomography (SPECT) is used in patients with acute stroke but as yet is of controversial value. We investigated an association of brain perfusion changes in stroke patients with stroke severity, volume of brain damage, and recovery. Methods Consecutive patients with hemispheric stroke were studied prospectively with serial neurological examinations using the Canadian Neurological Scale (CNS), CT, and Tc-99m-hexamethylpropyleneamine oxime (HMPAO) SPECT. Visual SPECT patterns of brain perfusion (normal, high, mixed, low, and absent) were correlated with the severity of stroke, lesion volume, and short-term outcome. Results SPECT studies were performed in a total of 458 consecutive acute stroke patients within 2 weeks after the onset (mean time, 5 days; range, 1 to 12 days). SPECT perfusion patterns correlated with stroke severity (CNS score) during the first 2 weeks (P<.001). Focal absence of brain perfusion on SPECT was associated with the largest volume of brain damage: 104 +/- 84 mt (P<.0001). SPECT perfusion patterns predicted the short-term outcome: 97% of patients with normal and increased HMPAO uptake made good recovery, 52% of those with decreased perfusion had moderate stroke, and 62% of patients with absent patterns fared badly. In a multiple logistic regression model, admission CNS scores had the strongest predictive value (P=.0001). SPECT had its own prognostic value independent of clinical judgment (P=.03). SPECT statistically improved predictive power of the CNS score (+1% receiver operating characteristic curve area, [chi(2)](2)=20, P<.001) because of distinction between focal decrease or absence of brain perfusion in patients studied within the first 72 hours of stroke. Conclusions Visual brain perfusion patterns correlate with the extent, severity, and short-term outcome of hemispheric stroke. HMPAO SPECT may improve the prognostic value of clinical examination if performed during the first 72 hours of stroke.