Perfusion CT in childhood stroke—Initial observations and review of the literature

Zebedin, D.; Sorantin, Erich; Riccabona, Michael

doi:10.1016/j.ejrad.2011.11.044

Cited by 13 publications

(7 citation statements)

References 34 publications

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“…However, the newest scanners with optimized protocols can image the entire cranium without substantial increases in radiation dose. All included studies did not report the safety of CTP except two studies that reported the administered radiation doses [33,34] which were lower than the recommended dose of 2.0–3.4 mSv described in the Hoeffner study [45]. The effective dose of CTP was 1.1/1.2 to 5 mSv, and it was not higher than NCCT, but it was less than CTA [46–49].…”

Section: Discussionmentioning

confidence: 99%

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

Shen

et al. 2017

PLoS ONE

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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.

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Section: Discussionmentioning

confidence: 99%

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

Shen

et al. 2017

PLoS ONE

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“…In a study of children with suspicion of craniosynostosis, the image quality was assessed using parameters’ image noise, image sharpness, overall diagnostic acceptability, and artifacts [26]. In another study, a subjective three-point scale ranging from very good to non-diagnostic image quality rating of perfusion disturbance, intracranial peripheral vessel depiction, and motion or streak artifacts was used [27].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

et al. 2019

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Objective To develop and assess the value and limitations of an image quality scoring criteria (IQSC) for pediatric CT exams. Methods IQSC was developed for subjective assessment of image quality using the scoring scale from 0 to 4, with 0 indicating desired anatomy or features not seen, 3 for adequate image quality, and 4 depicting higher than needed image quality. Pediatric CT examinations from 30 separate patients were selected, five each for routine chest, routine abdomen, kidney stone, appendicitis, craniosynostosis, and ventriculoperitoneal (VP) shunt. Five board-certified pediatric radiologists independently performed image quality evaluation using the proposed IQSC. The kappa statistics were used to assess the interobserver variability. Results All five radiologists gave a score of 3 to two-third (67%) of all CT exams, followed by a score of 4 for 29% of CT exams, and 2 for 4% exams. The median image quality scores for all exams were 3 and the interobserver agreement among five readers (acceptable image quality [scores 3 or 4] vs sub-optimal image quality ([scores 1 and 2]) was moderate to very good (kappa 0.4–1). For all five radiologists, the lesion detection was adequate for all CT exams. Conclusions The image quality scoring criteria covering routine and some clinical indication-based imaging scenarios for pediatric CT examinations has potential to offer a simple and practical tool for assessing image quality with a reasonable degree of interobserver agreement. A more extensive and multi-centric study is recommended to establish wider usefulness of these criteria.

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“…Contrast-enhanced computed tomography, computed tomography perfusion and computed tomography angiography are promising modalities for diagnosis of perfusion disturbances due to vascular occlusion in children with clinical suspicion of IS [23]. In a small study, computed tomography perfusion showed an 80% rate for detection of ischemic perfusion disturbances [23]. Yet, the existence of perfusion defect in itself is an inadequate pretext for administration of i.v.…”

Section: Diagnostic Predicamentsmentioning

confidence: 96%

“…rt-PA. In addition to ischemia, it is possible to observe perfusion disturbances in other conditions such as hemiplegic migraine [23][24][25]. The ultimate target for therapy, therefore, is the presence of an accompanying large vessel occlusion.…”

Section: Diagnostic Predicamentsmentioning

confidence: 97%

“…Based on an investigation by the Swiss Neuropaediatric Stroke Registry, the time to diagnosis by neuroimaging (primarily MRI) was <6 h in only 35% of children with acute IS [22]. Contrast-enhanced computed tomography, computed tomography perfusion and computed tomography angiography are promising modalities for diagnosis of perfusion disturbances due to vascular occlusion in children with clinical suspicion of IS [23]. In a small study, computed tomography perfusion showed an 80% rate for detection of ischemic perfusion disturbances [23].…”

Section: Diagnostic Predicamentsmentioning

confidence: 98%

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The prospects and predicaments of intravenous rt-PA in childhood ischemic stroke

Behrouz

2014

Expert Review of Neurotherapeutics

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One of the biggest conundrums in acute treatment of childhood arterial ischemic stroke is administration of intravenous recombinant tissue plasminogen activator. Although the benefit of this treatment is well-established in adults, the same effectiveness in children has not been demonstrated. Diversity of underlying causes of ischemic stroke in children and delay and uncertainty in diagnosis are some of the complexities that make intravenous thrombolysis elusive in this population. Physiological, pharmacological and developmental factors may also play roles in variable effect of intravenous recombinant tissue plasminogen activator in children. Current studies are aimed to determine the safety and efficacy of intravenous thrombolysis in carefully-selected children who would benefit the most from this procedure.

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Perfusion CT in childhood stroke—Initial observations and review of the literature

Cited by 13 publications

References 34 publications

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

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

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

The prospects and predicaments of intravenous rt-PA in childhood ischemic stroke

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