Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: A systematic review of 27 trials

Abstract

ObjectiveTo systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke.MethodsWe searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI. We used a hierarchical summary ROC model to summarize the sensitivity and specificity of CTP in detecting ischemic stroke.ResultsWe identified 27 studies with a total of 2168 patients. The pooled sensitivity of CTP for acute ischemic stroke was 82% (95% CI 75–88%), and the specificity was 96% (95% CI 89–99%). CTP was more sensitive than NCCT and had a similar accuracy with CTA. There were no statistically significant differences in the sensitivity and specificity between patients who underwent CTP within 6 hours of symptom onset and beyond 6 hours after symptom onset. No adverse events were reported in the included studies.ConclusionsCTP is more accurate than NCCT and has similar accuracy to CTA in detecting acute ischemic stroke. However, the evidence is not strong. There is potential benefit of using CTP to select stroke patients for treatment, but more high-quality evidence is needed to confirm this result.

Multiple Cerebrovascular Occlusion With Hypothyroidism: A Powerful Compensation

“…Although the patient had severe multiple vascular occlusion, dizziness as well as headache was main clinical manifestations, considering the strong compensatory mechanism of cerebral vessels mainly [12][13][14][15]: the left ICA occlusion, M1 segment of left brain artery occlusion, anterior communicating artery are open, and the right ICA system compensates the left cerebral anterior artery and middle cerebral artery through anterior communicating artery. The meningeal branch of left anterior cerebral artery supplied blood to left middle cerebral artery, and the signal of left middle cerebral artery M2 segment was low.…”

Perfluorocarbon Enhanced Glasgow Oxygen Level Dependent (GOLD) Magnetic Resonance Metabolic Imaging Identifies the Penumbra Following Acute Ischemic Stroke

“…Using the time to peak and mean transit times as surrogate measures of perfusion to identify the penumbra lack precision, as intracranial collateral blood flow pathways vary across individuals and brain regions. A recent systematic review incorporating more than 2000 patients across 27 studies was carried out to assess the diagnostic accuracy of CTP in acute ischemic stroke 38 . It concluded that more high quality evidence is required for CTP to be used as a diagnostic tool that can reliably inform on selection of stroke patients for treatment.…”

Interpreting CT perfusion in stroke

“…CT perfusion is more accurate at diagnosing acute ischaemic stroke than non-contrast CT alone, with two pooled analysis reporting high sensitivity (80%–82%) and very high specificity (95%–96%) for stroke 6 7. However, it is important also to be aware of its limitations in diagnosis.…”

“…In one study, CT perfusion had a sensitivity of 62% in detecting diffusion-weighted MRI confirmed lacunar infarcts compared with just 19% for non-contrast CT 8. Sensitivity for posterior circulation infarcts is lower than for hemispheric cortical infarcts, but CT perfusion is more sensitive in diagnosing acute posterior circulation stroke than non-contrast CT, with reported sensitivity of 76% and specificity of 93% 6…”

“…The volumes of CT perfusion-defined core infarcts correlate well with diffusion-weighted MRI lesion volumes at presentation, and also predict infarct size on MRI after 24 hours (see figure 6). 6 In those who do not achieve reperfusion, CT perfusion predicts the resultant infarct volume from progression of hypoperfused tissue (core and penumbra volumes combined) and predicts the infarct volume in those where the at-risk tissue is saved (core volume only). Established thresholds for defining core and penumbra have been derived from comparing CT perfusion to diffusion-weighted MRI; however, these comparisons are largely from patients who have either not received therapy or were treated with thrombolysis 10.…”