Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study

Lee, In Hyouk; You, Joshua H.; Lee, Ji Yong; Whang, Kum; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub

doi:10.1007/s00234-010-0689-2

Cited by 23 publications

(31 citation statements)

References 11 publications

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“…In this study, no significant differences between detection of infratentorial and supratentorial stroke lesions were found. 8 Sensitivity and specificity for detection of infratentorial ischemic lesions were, respectively, 91% and 93%. The longer duration from stroke onset to imaging in this study (mean 540 versus 227 minutes) probably accentuated ischemic changes and therefore increased sensitivity.…”

Section: Discussionmentioning

confidence: 97%

Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Hoeven

Dankbaar

Algra

et al. 2015

Stroke

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P osterior circulation stroke accounts for 20% of ischemic strokes. Clinical signs and symptoms of anterior and posterior ischemic stroke may overlap, causing a delay in making the correct diagnosis. 1 In the acute stage, noncontrast computed tomography (NCCT) is used to exclude cerebral hemorrhage and pathologies other than ischemic stroke and to detect early signs of ischemia. CT angiography (CTA) can provide information on the presence and site of an arterial occlusion. CTA source images (CTA-SI) can also help to detect ischemic changes.2 CT perfusion (CTP) can detect ischemic perfusion defects, with a pooled analysis sensitivity of 80% (95% confidence interval [CI], 72%-86%) and a specificity of 95% (95% CI, 86%-98%) for early diagnosis of stroke. 3 The additional diagnostic value of CTP compared with NCCT and CTA for posterior circulation stroke has not been analyzed.We investigated the additional diagnostic value of CTP to CTA-SI and NCCT for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. Methods PatientsAll patients participated in the prospective, multicenter, observational Dutch acute stroke study (DUST; ClinicalTrials.gov NCT00880113) in which the diagnostic values of CTA and CTP within 9 hours after onset of the neurological deficit were investigated in patients with acute ischemic stroke. 4 We selected consecutive patients between May 2009 and December 2012 with suspected acute posterior circulation ischemic stroke as defined in the Oxfordshire classification. 5Reasons for exclusion were poor image quality, not all 3 posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) 6 levels included in the CTP slab or missing follow-up imaging.Background and Purpose-Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. Methods-Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. Results-Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; ...

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Section: Discussionmentioning

confidence: 97%

Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Hoeven

Dankbaar

Algra

et al. 2015

Stroke

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“…CTP studies show that there is a high rate of intracerebral perfusion deficits that occur without subsequent ischemic lesions in the follow-up MRI. 11,[23][24][25] In ≤20% of patients without cerebral infarction, time-related maps, such as MMT and time to peak, showed a perfusion deficit, whereas CBF showed a perfusion deficit in 5% of the patients without infarction. 11 Our results indicate that infratentorial perfusion deficits, which sometimes are regarded as false-positive, can actually have a pathophysiologic background.…”

Section: May 2014mentioning

confidence: 99%

“…11,[23][24][25] In ≤20% of patients without cerebral infarction, time-related maps, such as MMT and time to peak, showed a perfusion deficit, whereas CBF showed a perfusion deficit in 5% of the patients without infarction. 11 Our results indicate that infratentorial perfusion deficits, which sometimes are regarded as false-positive, can actually have a pathophysiologic background. However, one has to keep in mind that time-related maps are particularly susceptible for perfusion alterations and always have to be interpreted along with CBF and CTA.…”

Section: May 2014mentioning

confidence: 99%

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Vertebral Artery Hypoplasia

Thierfelder

Baumann

Sommer

et al. 2014

Stroke

104

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Background and Purpose-Vertebral artery hypoplasia (VAH) is supposed to be a risk factor for posterior circulation ischemia (PCI), particularly in the territory of the posterior inferior cerebellar artery (PICA). The aim of our study was to determine whether VAH impedes perfusion in the dependent PICA territory even in the absence of manifest PCI. Methods-VA diameter was retrospectively measured in 934 consecutive patients who underwent whole-brain multimodal computed tomography because of suspected stroke. VAH was defined by a diameter of ≤2 mm and an asymmetry ratio of ≤1:1.7 of both VAs. We performed blinded computed tomography perfusion reading in patients with VAH without PCI (MRI-confirmed) and in control patients (ratio 1:2) with normal VAs. Four different perfusion maps were evaluated for a relative hypoperfusion in the PICA territory. Results-VAH was found in 146 of 934 patients (15.6%). It was more frequent on the right side (66.1%). Of 146 patients, 59without PCI qualified for computed tomography perfusion analysis. Depending on the perfusion map, ≤42.4% (25/59) of patients with VAH, but only 7.6% (9/118) without VAH, showed an ipsilateral PICA hypoperfusion (P<0.001). Sensitivities in patients with VAH were as follows: time to drain 42.4% (25/59)>mean transit time 39.0% (23/59)>cerebral blood flow 25.4% (15/59). Cerebral blood volume was never affected. Conclusions-VAH is a frequent vascular variant that can lead to a relative regional hypoperfusion in the PICA territory.Additional research should clarify the pathophysiological role of VAH in PCI.

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“…Data of other authors describing a relatively high sensitivity and specificity of PCT in connection with the toggling table technique is currently available. However, these studies either include study populations with disease entities other than cerebral ischemia [14] or examine ischemia in infratentorial sections of the brain [28]. In other cases, the technique applied by other workgroups differed in that a combination of CTA and PCT was used in one examination procedure [13].…”

Section: Discussionmentioning

confidence: 99%

Whole-Brain Perfusion CT Using a Toggling Table Technique to Predict Final Infarct Volume in Acute Ischemic Stroke

Schrader

Wilk²,

Jansen³

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate how accurately final infarct volume in acute ischemic stroke can be predicted with perfusion CT (PCT) using a 64-MDCT unit and the toggling table technique. Materials and Methods: Retrospective analysis of 89 patients with acute ischemic stroke who underwent CCT, CT angiography (CTA) and PCT using the ?toggling table? technique within the first three hours after symptom onset. In patients with successful thrombolytic therapy (n?=?48) and in those without effective thrombolytic therapy (n?=?41), the infarct volume and the volume of the penumbra on PCT were compared to the infarct size on follow-up images (CT or MRI) performed within 8 days. The feasibility of complete infarct volume prediction by 8?cm cranio-caudal coverage was evaluated. Results: The correlation between the volume of hypoperfusion on PCT defined by cerebral blood volume reduction and final infarct volume was strongest in patients with successful thrombolytic therapy with underestimation of the definite infarct volume by 8.5?ml on average. The CBV map had the greatest prognostic value. In patients without successful thrombolytic therapy, the final infarct volume was overestimated by 12.1?ml compared to the MTT map on PCT. All infarcts were detected completely. There were no false-positive or false-negative results. Conclusion: Using PCT and the ?toggling table? technique in acute stroke patients is helpful for the rapid and accurate quantification of the minimal final infarct and is therefore a prognostic parameter which has to be evaluated in further studies to assess its impact on therapeutic decision. Key Points: Citation Format:

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Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study

Abstract: This was the first study to investigate the accuracy of PCT with the toggling table technique in detection of infratentorial stroke lesions. Clinically, PCT is highly reliable and accurate in detecting infratentorial stroke lesions.

Cited by 23 publications

References 11 publications

Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Vertebral Artery Hypoplasia

Whole-Brain Perfusion CT Using a Toggling Table Technique to Predict Final Infarct Volume in Acute Ischemic Stroke

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