Additional diagnostic value of computed tomography perfusion for detection of acute ischemic stroke in the posterior circulation

Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation st...

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Bibliographic Details
Published in:Stroke (1970) 2015-04, Vol.46 (4), p.1113-1115
Main Authors: van der Hoeven, Erik J R J, Dankbaar, Jan Willem, Algra, Ale, Vos, Jan Albert, Niesten, Joris M, van Seeters, Tom, van der Schaaf, Irene C, Schonewille, Wouter J, Kappelle, L Jaap, Velthuis, Birgitta K
Format: Article
Language:English
Subjects:
Aged
Brain Ischemia - diagnosis
Cerebellum - pathology
Cerebral Angiography
Cerebral Infarction - diagnosis
Cerebrovascular Circulation - physiology
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Models, Neurological
Posterior Cerebral Artery - pathology
Predictive Value of Tests
Stroke - diagnosis
Thalamus - pathology
Tomography, X-Ray Computed - methods
Tomography, X-Ray Computed - standards
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Summary:Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; P(C versus A)
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.115.008718