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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

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Cerebrovasc Dis 2016;41:242-247

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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


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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

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