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Eur J Cardiothorac Surg 2007;32:521-526. doi:10.1016/j.ejcts.2007.05.024
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
a Department of Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
b Department of Cardiothoracic Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
Received 27 December 2006; received in revised form 30 May 2007; accepted 31 May 2007.
* Corresponding author. Address: Department of Radiology, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. Tel.: +49 69 6301 7260; fax: +49 69 6301 5252. (Email: s.bisdas{at}med.uni-frankfurt.de).
Objective: Adverse neurologic outcomes, like stroke, in intensive care unit (ICU) patients after cardiac surgery can have devastating consequences, among them increased mortality risk and, among survivors, loss of independence and a diminished quality of life. Non-contrast computed tomography (CT) remains a widely utilised modality for assessing stroke; however, it has a low sensitivity in the acute phase. Perfusion CT (PCT) has the potential of imaging stroke in its hyperacute phase. We evaluated the feasibility and results of the method among patients from the ICU. Methods: The NCCT and PCT images of 33 retrospectively identified patients were included in this study. The diagnostic contribution of the PCT to patient management was classified according to one of three categories: (A) those that changed the preliminary (NCCT) diagnosis; (B) those that revealed additional pathology and/or specified more exactly findings that have been detected by NCCT or clinically suspected; and (C) confirmed the preliminary diagnosis. Neurologic outcome variables were also documented and associated with PCT lesions. Results: Fifteen patients after coronary artery bypass graft (CABG) operation, 14 patients after CABG and valve surgery, and 4 patients after an aortic dissection (Type A) surgery underwent a NCCT with PCT 2.4 ± 1.3 days after the operation. Twenty patients had bilateral internal carotid artery (ICA) stenosis (>50%), 11 patients had unilateral ICA stenosis (>75%), and 2 patients had no ICA stenosis. In nine patients (27.2%) the PCT changed the initial diagnosis of the NCCT and revealed ischaemic pathology. In 24 patients (72.7%), the performed PCT revealed additional pathology and/or more completely characterised findings that have been detected by the initial NCCT. In nine patients, PCT confirmed only the initial diagnosis. Patients with normal PCT findings had a favourable outcome; patients with large lesions in PCT in one or more vascular territories had an unfavourable outcome; seven patients with lesions in basal ganglia and/or semioval centre had a favourable outcome. Conclusions: PCT shows a greater sensitivity in detecting and mapping acute ischaemic stroke in ICU patients (after cardiac surgery) in whom conventional imaging findings are not in line with the severity of the clinical condition.
Key Words: CT • Perfusion CT • Intensive care unit • Stroke
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