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Vol. 28, No. 1, 2009
Issue release date: June 2009
Section title: Original Paper
Cerebrovasc Dis 2009;28:72–79
(DOI:10.1159/000219300)

Perfusion CT Improves Diagnostic Accuracy for Hyperacute Ischemic Stroke in the 3-Hour Window: Study of 100 Patients with Diffusion MRI Confirmation

Lin K. · Do K.G. · Ong P. · Shapiro M. · Babb J.S. · Siller K.A. · Pramanik B.K.
Departments of aRadiology and bNeurology, New York University Langone Medical Center, New York, N.Y., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/27/2008
Accepted: 3/2/2009
Published online: 5/20/2009
Issue release date: June 2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Purpose: Conventional noncontrast CT (NCCT) is insensitive to hyperacute cerebral infarction in the first 3 h. Our aim was to determine if CT perfusion (CTP) can improve diagnostic accuracy over NCCT for patients presenting with stroke symptoms in the 3-hour window. Methods: Consecutive patients presenting to our emergency department with symptoms of ischemic stroke <3 h old and receiving NCCT and CTP as part of their triage evaluation were retrospectively reviewed. Patients with follow-up diffusion-weighted MRI (DWI) <7 days from ictus were included. Two readers rated the NCCT and CTP for evidence of acute infarct and its vascular territory. CTP selectively covered 24 mm of brain centered at the basal ganglia with low relative cerebral blood volume in a region of low cerebral blood flow or elevated time to peak as the operational definition for infarction. A third reader rated all follow-up DWI for acute infarct and its vascular territory as the reference standard. Sensitivity, specificity, and predictive values were calculated. An exact McNemar test and generalized estimating equations from a binary logistic regression model were used to assess the difference in detection rates between modalities. A two-sided p value <0.05 was considered significant. Results: 100 patients were included. Sixty-five (65%) patients had follow-up DWI confirmation of acute infarct. NCCT revealed 17 (26.2%) acute infarcts without false positives. CTP revealed 42 (64.6%) acute infarcts with one false positive. Of the 23 infarcts missed on CTP, 10 (43.5%) were outside the volume of coverage while the remaining 13 (56.5%) were small cortical or lacunar type infarcts (≤15 mm in size). CTP was significantly more sensitive (64.6 vs. 26.2%, p < 0.0001) and accurate (76.0 vs. 52%, p < 0.0001) and had a better negative predictive value (59.6 vs. 42.2%, p = 0.032) than NCCT. Conclusion: In a retrospective cohort of 100 patients with symptoms of hyperacute stroke in the 3-hour window, CTP provided improved sensitivity and accuracy over NCCT.


  

Author Contacts

Ke Lin, MD
Department of Radiology, HCC Basement-MRI
530 First Avenue
New York, NY 10016 (USA)
Tel. +1 212 263 3567, Fax +1 212 263 7666, E-Mail kelinmd@gmail.com

  

Article Information

Received: October 27, 2008
Accepted: March 2, 2009
Published online: May 20, 2009
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 2, Number of References : 30

  

Publication Details

Cerebrovascular Diseases

Vol. 28, No. 1, Year 2009 (Cover Date: June 2009)

Journal Editor: Hennerici M.G. (Mannheim)
ISSN: 1015-9770 (Print), eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/27/2008
Accepted: 3/2/2009
Published online: 5/20/2009
Issue release date: June 2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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