Low dose CT perfusion in acute ischemic stroke

Murphy, Amanda; Lee, Ting‐Yim; Symons, Sean; Jakubovic, Raphael; Zhang, Liying; Aviv, Richard I.

doi:10.1007/s00234-014-1434-z

Cited by 32 publications

(15 citation statements)

References 24 publications

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“…A right hemipontine acute infarction was confirmed on MRI that was obtained 4 days later as shown on DWI/ADC (e) and corresponding FLAIR (f) NCCT non-contrast CT, CTA-SI CTA Source Images, CTP CT perfusion achievable (ALARA) principle. A recent study shows that no quantitative CTP parameter differences were demonstrated when CTP dose was reduced by 50 % from 100 mA to 50 mA, however it remains unclear whether performance for infarct detection will remain the same at this reduced dose [31]. Scan obliquity ensures that no significant lens dose exposure occurs unlike CTA which remains the largest single dose contributor.…”

Section: Discussionmentioning

confidence: 92%

The predictive value of a targeted posterior fossa multimodal stroke protocol for the diagnosis of acute posterior ischemic stroke

Sharon¹,

Boyle

Yeung³

et al. 2016

Neurovasc Imaging

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Background: There is limited but growing research regarding the accuracy of CTP in diagnosing acute posterior ischemia stroke. We sought to evaluate the diagnostic accuracy of an incremental multimodal CT protocol in acute posterior ischemic stroke. Methods: Retrospective review of incremental NCCT, CTA-source images and CTP use in 82 consecutive patients with acute posterior ischemic stroke. Readers were blinded to infarct status on follow-up imaging (MRI or CT). Predictive effects of observed diagnostic accuracy and confidence score were quantified with the entropy r 2 value. Sensitivity, specificity, and CI were calculated accounting for multiple reader assessments. Receiver Operating Characteristic analyses, including Area Under the Curve, were conducted for the three modalities. Inter-reader agreement was established with Intraclass Correlation Coefficient.

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Section: Discussionmentioning

confidence: 92%

The predictive value of a targeted posterior fossa multimodal stroke protocol for the diagnosis of acute posterior ischemic stroke

Sharon¹,

Boyle

Yeung³

et al. 2016

Neurovasc Imaging

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“…This could be an important [24,25]. Increased dose concerns may be addressed by imaging at 50 mA rather than 100mAs, nulling any increased radiation dose by halving MA and doubling spatial coverage [26]. CTP (2.5 mSV) contributes approximately 30 % of total CT Stroke protocol dose (6.1 mSv) with CTA an equal contributor (2.4 mSV).…”

Section: Discussionmentioning

confidence: 99%

Can CT perfusion accurately assess infarct core?

et al. 2016

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Background: We sought to quantify CTP-derived infarct core applying previously published perfusion thresholds to multi-institutional CTP data to assess the margin of error for 25 mL and 70 mL critical volume thresholds using early DWI as a reference standard. Methods: 60 patients with acute ischemic stroke undergoing CTP and DWI within 6 and 24 h of symptom onset, respectively, were retrospectively analyzed from 3 tertiary care centers. CTP-derived infarct core was calculated using published thresholds for absolute and relative CBF and CBV in addition to manual CBV tracing. Using DWI as the reference standard, performance of CTP-derived measures of infarct core was assessed using co-registered voxel-by-voxel analysis and total infarct volume comparison. Volumes of each CTP infarct core estimate were compared against DWI to determine the degree of infarct core over or underestimation at the critical volumes of 25 mL and 70 mL. Results: Median core infarct volume was 10.8 mL. Mean CTP-derived infarct core volumes were similar to DWI for all CTP threshold methods to within ± 1 mL. CBV tracing demonstrated an overall significant core overestimation compared to DWI (p = 0.017). All CTP core volume estimations showed robust correlation with DWI (Pearson pvalue < 0.001). As core volume increased, CTP demonstrated increased deviation from DWI. At the critical cut-offs of 25 mL and 70 mL, relative CBF demonstrated the best agreement with DWI for infarct core compared to the other CTP-derived measures of infarct core. Conclusion: Our study demonstrates close approximation between multiple CTP-derived measures of infarct core and DWI infarct volume, Especially relative CBF.

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“…A recent study has shown that this could be reduced by 50% by using 50 mA instead of 100 mA. 32 Furthermore, due to scan obliquity, no significant lens dose exposure was experienced. The largest contributor to dose remains the CTA component, due to spatial coverage and exposure to the thyroid and lenses.…”

Section: Discussionmentioning

confidence: 99%