Systematic comparison of perfusion‐CT and CT‐angiography in acute stroke patients

Tan, Jessica; Dillon, William P.; Liu, Songling; Adler, Felix; Smith, Wade S.; Wintermark, Max

doi:10.1002/ana.21130

Cited by 330 publications

(271 citation statements)

References 16 publications

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“…7 Compared to CTASI, perfusion CT (CTP) better delineates the ischemic core and can identify areas of salvageable brain tissue in anterior circulation stroke. 24,25 Similar findings in the posterior circulation are conceivable. Comparison of CTA, CTP and multimodal MRI to predict outcome and treatment response in patients with BAO could be subject of future studies.…”

Section: Discussionsupporting

confidence: 52%

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Puetz

Sylaja²,

Coutts³

et al. 2008

Stroke

366

304

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Background and Purpose-Quantification of early ischemic changes (EIC) may predict functional outcome in patients with basilar artery occlusion (BAO). We tested the validity of a novel CT score, the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS). Methods-Pc-ASPECTS allots the posterior circulation 10 points. Two points each are subtracted for EIC in midbrain or pons and 1 point each for EIC in left or right thalamus, cerebellum or PCA-territory, respectively. We studied 2 different populations: (1) patients with suspected vertebrobasilar ischemia and (2) patients with BAO. We applied pc-ASPECTS to noncontrast CT (NCCT), CT angiography source images (CTASI), and follow-up image by 3-reader consensus. We calculated sensitivity for ischemic changes and analyzed the predictivity of pc-ASPECTS for independent (modified Rankin Scale [mRS] score Յ2) and favorable (mRS score Յ3) outcome. Results-Of 130 patients with suspected vertebrobasilar ischemia, 72% (94) had posterior circulation stroke, 8% (10) transient ischemic attack, and 20% (26)

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Section: Discussionsupporting

confidence: 52%

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Puetz

Sylaja²,

Coutts³

et al. 2008

Stroke

366

304

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“…The predictive value of the morphologic extent is consistent with previous reports using dynamic CTA and other imaging techniques. 4,14,26 Notably, both delay and extent remained independent predictors after correcting for IV thrombolysis and mechanical thrombectomy. This suggests the beneficial effect of good collateralization in dynamic CTA, even in the absence of interventions.…”

Section: Discussionmentioning

confidence: 94%

“…4,6,[8][9][10] The latter offers the advantages of short scan times and wide availability. In conventional CTA, however, the assessment of collaterals is heavily dependent on the timing of image acquisition.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 ± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P o 0.001) and a large relative mismatch (P o 0.001) on initial CTP, of a small follow-up lesion (P o 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

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“…CT scanners are widely available, accessible, and less expensive to operate compared with MR units. The use of extended CT protocols, including CT angiography and CT perfusion imaging, increases confidence in diagnosing and delineating stroke (44)(45)(46). Occlusion site and perfusion defect size are important considerations in determining the outcome of revascularization procedures and defining a target population for treatment (47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion

Aviv

d’Esterre²,

Murphy³

et al. 2009

Radiology

153

112

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Purpose:To determine whether admission computed tomography (CT) perfusion-derived permeability-surface area product (PS) maps differ between patients with hemorrhagic acute stroke and those with nonhemorrhagic acute stroke. Materials and Methods:This prospective study was institutional review board approved, and all participants gave written informed consent. Forty-one patients who presented with acute stroke within 3 hours after stroke symptom onset underwent two-phase CT perfusion imaging, which enabled PS measurement. Patients were assigned to groups according to whether they had hemorrhage transformation (HT) at follow-up magnetic resonance (MR) imaging and CT and/or whether they received tissue plasminogen activator (TPA) treatment. Clinical, demographic, and CT perfusion variables were compared between the HT and non-HT patient groups. Associations between PS and HT were tested at univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) analysis. Results:HT developed in 23 (56%) patients. Patients with HT had higher National Institutes of Health Stroke Scale (NIHSS) scores (P ϭ .005), poorer outcomes (P ϭ .001), and a higher likelihood of having received TPA (P ϭ .005) compared with patients without HT. Baseline blood flow (P ϭ .17) and blood volume (P ϭ .11) defects and extent of flow reduction (P ϭ .27) were comparable between the two groups. The mean PS for the HT group, 0.49 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 , was significantly higher than that for the non-HT group, 0.09 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 (P Ͻ .0001). PS (odds ratio, 3.5; 95% confidence interval [CI]: 1.69, 7.06; P ϭ .0007) and size of hypoattenuating area at nonenhanced admission CT (odds ratio, 0.4; 95% CI: 0.2, 0.7; P ϭ .002) were the only independent variables associated with HT at stepwise multivariate analysis. The mean area under the ROC curve was 0.918 (95% CI: 0.828, 1.00). The PS threshold of 0.23 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 had 77% sensitivity and 94% specificity for detection of HT. Conclusion:Admission PS measurement appears promising for distinguishing patients with acute stroke who are likely from those who are not likely to develop HT.

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Systematic comparison of perfusion‐CT and CT‐angiography in acute stroke patients

Abstract: The most accurate assessment of the site of occlusion, infarct core, salvageable brain tissue, and collateral circulation in patients suspected of acute stroke is afforded by a combination of PCT and CTA.

Cited by 330 publications

References 16 publications

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion

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