Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Free Access

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Sporns P.a · Schmidt R.c · Minnerup J.b · Dziewas R.b · Kemmling A.e · Dittrich R.b · Zoubi T.a · Heermann P.a · Cnyrim C.a · Schwindt W.a · Heindel W.a · Niederstadt T.a · Hanning U.a, d

Author affiliations

aDepartment of Clinical Radiology and bDepartment of Neurology, University Hospital of Muenster, cInstitute of Biostatistics and Clinical Research, dDepartment of Epidemiology and Social Medicine, University of Muenster, Muenster, eInstitute of Neuroradiology, University Hospital of Luebeck, Luebeck, Germany

Corresponding Author

Uta Hanning, MD and Peter Sporns, MD

Department of Clinical Radiology and Department of Epidemiology and Social Medicine, University Hospital of Muenster

Albert-Schweitzer-Campus 1, Gebäude D3, DE-48149 Muenster (Germany)

E-Mail uhanning@uni-muenster.de; Peter.Sporns@ukmuenster.de

Related Articles for ""

Cerebrovasc Dis 2016;41:242-247

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Abstract

Background and Purpose: Computed tomography perfusion (CTP) has a high diagnostic value in the detection of acute ischemic stroke in the anterior circulation. However, the diagnostic value in suspected posterior circulation (PC) stroke is uncertain, and whole brain volume perfusion is not yet in widespread use. We therefore studied the additional value of whole brain volume perfusion to non-contrast CT (NCCT) and CT angiography source images (CTA-SI) for infarct detection in patients with suspected acute ischemic PC stroke. Methods: This is a retrospective review of patients with suspected stroke in the PC in a database of our stroke center (n = 3,011) who underwent NCCT, CTA and CTP within 9 h after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and pc-ASPECTS locations of ischemia. Three imaging models - A (NCCT), B (NCCT + CTA-SI) and C (NCCT + CTA-SI + CTP) - were compared with regard to the misclassification rate relative to gold standard (infarction in follow-up imaging) using the McNemar's test. Results: Of 3,011 stroke patients, 267 patients had a suspected stroke in the PC and 188 patients (70.4%) evidenced a PC infarct on follow-up imaging. The sensitivity of Model C (76.6%) was higher compared with that of Model A (21.3%) and Model B (43.6%). CTP detected significantly more ischemic lesions, especially in the cerebellum, posterior cerebral artery territory and thalami. Conclusions: Our findings in a large cohort of consecutive patients show that CTP detects significantly more ischemic strokes in the PC than CTA and NCCT alone.

© 2016 S. Karger AG, Basel


References

  1. Biesbroek JM, Niesten JM, Dankbaar JW, Biessels GJ, Velthuis BK, Reitsma JB, et al: Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis 2013;35:493-501.
  2. Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW: Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke 2012;43:2648-2653.
  3. van der Hoeven EJ, Dankbaar JW, Algra A, Vos JA, Niesten JM, van Seeters T, et al: Additional diagnostic value of computed tomography perfusion for detection of acute ischemic stroke in the posterior circulation. Stroke 2015;46:1113-1115.
  4. Lee IH, You JH, Lee JY, Whang K, Kim MS, Kim YJ, et al: Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study. Neuroradiology 2010;52:1095-1100.
  5. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521-1526.
  6. Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, et al: Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 2008;39:2485-2490.
  7. Thierfelder KM, Sommer WH, Baumann AB, Klotz E, Meinel FG, Strobl FF, et al: Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke. Neuroradiology 2013;55:827-835.
  8. Holm S: A simple sequentially rejective multiple test procedure. Scand J Stat 1979;6:65-70.
  9. McKinney A, Truwit CL, Kieffer S: Reversibility of an ‘apparent' infarct on dynamic perfusion CT after lytic therapy: comment regarding cerebral blood flow and blood volume thresholds. AJNR Am J Neuroradiol 2006;27:1391-1392; author reply 1392-1393.
  10. Puetz V, Sylaja PN, Hill MD, Coutts SB, Dzialowski I, Becker U, et al: CT angiography source images predict final infarct extent in patients with basilar artery occlusion. AJNR Am J Neuroradiol 2009;30:1877-1883.
  11. Moreau F, Asdaghi N, Modi J, Goyal M, Coutts SB: Magnetic resonance imaging versus CT in transient ischemic attack and minor stroke: the more you see the more you know. Cerebrovasc Dis Extra 2013;3:130-136.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 28, 2015
Accepted: December 21, 2015
Published online: January 29, 2016
Issue release date: April 2016

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 4

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

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


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.