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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain

Body Temperature Modulates Infarction Growth following Endovascular Reperfusion

S. Dehkharghani, M. Bowen, D.C. Haussen, T. Gleason, A. Prater, Q. Cai, J. Kang and R.G. Nogueira
American Journal of Neuroradiology January 2017, 38 (1) 46-51; DOI: https://doi.org/10.3174/ajnr.A4969
S. Dehkharghani
aFrom the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia
bDepartment of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia
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  • ORCID record for S. Dehkharghani
M. Bowen
aFrom the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia
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D.C. Haussen
bDepartment of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia
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T. Gleason
aFrom the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia
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A. Prater
aFrom the Department of Radiology and Imaging Sciences (S.D., M.B., T.G., A.P.), Emory University Hospital, Atlanta, Georgia
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Q. Cai
cDepartment of Biostatistics (Q.C.), Emory University, Atlanta, Georgia
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J. Kang
dDepartment of Biostatistics (J.K.), University of Michigan, Ann Arbor, Michigan.
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R.G. Nogueira
bDepartment of Neurology (S.D., D.C.H., R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, Georgia
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    Fig 1.

    CT perfusion mismatch maps for infarct core and penumbral volume estimates. Representative sample of the CT perfusion analysis pipeline with estimated infarction core (A) determined as relative cerebral blood flow <30% of normal and total hypoperfused tissue volume (B) measured from regions of time-to-maximum of residue function of >6 seconds. Lesion estimates (white overlays) produced from sequential sections obtained from presentation CT perfusion in a 62-year-old woman presenting with acute left MCA syndrome. Segmented lesions are overlaid on raw perfusion images for review purposes, and automated lesion volumes are produced as shown. Penumbral mismatch is computed from the difference between estimated lesion volumes and is summed for each of 2 contiguous perfusion slabs.

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    Table 1:

    Patient characteristics and temperature profilea

    Characteristics
    Mean age (yr)65 (range, 18–94)
    NIHSS score18 (14–22)
    Women60 (46.5%)
    Presentation core infarction volumeb9.6 mL (1.5–25.3)
    Hypoperfused volumec132.6 mL (84.2–204)
    Occluded vesselsn (%)
        Intracranial ICA17 (13.2%)
        Extracranial ICA2 (1.6%)
        M1 MCA63 (48.8%)
        M2 MCA24 (18.6%)
        ACA4 (3.1%)
        Vertebrobasilar1 (0.8%)
        Tandem18 (14%)
    Reperfusion score
        mTICI 2b67 (52.9%)
        mTICI 362 (48.1%)
    Last known well to reperfusion414 min (295–572)
    CTP to reperfusion119 min (84–162)
    Procedure time to reperfusion58.0 min (38.5–94.5)
    Total procedural duration77 min (51–118)
    CTP-to-MRI time26.8 hr (20–47.2)
    Last known well to MRI30.6 hr (24.0–51.2)
    General anesthesia (No.)44 (34.1%)
    Aspirin therapy (No.)125 (96.9%)
    Received acetaminophen (No.)91 (70.5%)
    Final infarct volume19.6 mL (8.3–45.2 mL)
    Mean 90-day mRS2
    Favorable clinical outcome (mRS ≤2) (No.)77 (59.7%)
    90-day mortality (No.)11 (8.5%)
    Population temperature minima (mean)35.3°C
    Population temperature maxima (mean)37.9°C
    Per-patient temperature fluctuation2.4°C (1.8°C–3.3°C)
    Temperature increase from baseline1.6°C (1.0°C–2.5°C)
    • Note:—ACA indicates anterior cerebral artery.

    • ↵a Data are reported as proportions and median (IQR), unless otherwise stated.

    • ↵b Relative cerebral blood flow <30% of contralateral normal tissues.

    • ↵c Tmax of >6 seconds.

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    Table 2:

    Optimal model for prediction of favorable clinical outcome: variable selection by Akaike Information Criteriona

    VariableOdds Ratio95% CIP Value
    Fever (>37.5°C)0.310.09–0.96.052
    Age0.960.92–0.99.007
    Total procedure time0.990.98–0.995.003
    NIHSS score0.840.75–0.92<.001
    • ↵a Variable selection using Akaike Information Criterion minimization, indicated by the goodness-of-fit test (P > .05), and the likelihood ratio test for inclusion of fever (P = .041) vs exclusion of fever in the prediction of favorable clinical outcome.

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American Journal of Neuroradiology: 38 (1)
American Journal of Neuroradiology
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Cite this article
S. Dehkharghani, M. Bowen, D.C. Haussen, T. Gleason, A. Prater, Q. Cai, J. Kang, R.G. Nogueira
Body Temperature Modulates Infarction Growth following Endovascular Reperfusion
American Journal of Neuroradiology Jan 2017, 38 (1) 46-51; DOI: 10.3174/ajnr.A4969

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Body Temperature Modulates Infarction Growth following Endovascular Reperfusion
S. Dehkharghani, M. Bowen, D.C. Haussen, T. Gleason, A. Prater, Q. Cai, J. Kang, R.G. Nogueira
American Journal of Neuroradiology Jan 2017, 38 (1) 46-51; DOI: 10.3174/ajnr.A4969
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