Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Hoeven, E.J.; Dankbaar, Jan Willem; Algra, Ale; Vos, Jan Albert; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Schonewille, Wouter J.; Kappelle, L. Jaap; Velthuis, Birgitta K.

doi:10.1161/strokeaha.115.008718

Cited by 61 publications

(51 citation statements)

References 9 publications

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“…In our study, the pc-ASPECTS region pons/ midbrain evidenced the largest rate of misclassifications in all imaging models. However, the rate for detection of brain stem infarcts was slightly higher than in comparable studies [3,4] . This might be according to basilar occlusions (with a higher rate of CTP alterations in the brain stem), which have been moved to our hospital as a regional stroke center.…”

Section: Discussioncontrasting

confidence: 62%

“…The higher rate of detected infarctions on follow-up imaging, especially in the brain stem, is best explained by the much higher rate of MRI as follow-up examination [11] compared to the other studies [3,4] .…”

Section: Discussionmentioning

confidence: 86%

“…Van der Hoeven et al [3] report that the detection rate of ischemic lesions using CTP was significantly higher than by CTA and NCCT alone especially in the cerebellum, posterior cerebral artery territory and the thalami. However, patient populations were relatively small, and the diagnostic accuracy of the different diagnostic models was not tested and isolated for each pc-ASPECT's region.…”

mentioning

confidence: 99%

“…A recent study proposes an increase in diagnostic accuracy by additional CT whole brain volume perfusion to protocols including only CT angiography (CTA) and non-contrast CT (NCCT) [3] . Another blinded study recognized no significant difference in the detection of supratentorial and infratentorial stroke lesions [4] .…”

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confidence: 99%

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Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Sporns¹,

Schmidt

Minnerup

et al. 2016

Cerebrovasc Dis

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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.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 86%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Sporns¹,

Schmidt

Minnerup

et al. 2016

Cerebrovasc Dis

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“…CTP however can be directed to evaluate the posterior fossa according to clinical presentation. Literature regarding the diagnostic performance of posteriorfossa CTP is limited but growing with only three recently published articles [10][11][12]. Advances in CT such as a table-toggle technique or increase detector number [13], now facilitate more extensive brain coverage with increasing visualization of the posterior fossa.…”

Section: Introductionmentioning

confidence: 99%

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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Safety and Outcome of Intra-Arterial Treatment for Basilar Artery Occlusion

et al. 2016

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IMPORTANCE After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO). OBJECTIVE To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome. DESIGN, SETTING, AND PARTICIPANTS Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center.EXPOSURES Intra-arterial treatment by mechanical thrombectomy and/or IA thrombolysis. MAIN OUTCOMES AND MEASURESAdequate recanalization was defined as a score of 2b or 3 on the Thrombolysis in Cerebral Infarction score. Favorable outcome was defined as a modified Rankin Scale of 0 to 3 at first follow-up. Imaging data on the patency of the vertebral arteries and posterior communicating arteries, as well as the presence of cerebellar arterial anastomosis, were recorded and posttreatment imaging results were reviewed. RESULTSOf the 38 patients with BAO, mean (SD) age was 58 (16) years, and 21 (55%) were male. Twenty-seven patients (71%) were treated with intravenous thrombolysis before IA therapy. Mechanical thrombectomy was applied to 30 patients, and 7 patients received local urokinase without thrombectomy. The median National Institutes of Health Stroke Scale score was 21 (interquartile range [IQR], 15-32) points, and median time to IA treatment was 288 (IQR, 216-380) minutes. Adequate recanalization was achieved in 34 of 38 cases (89%). Functional outcome was favorable in 19 (50%) patients. No association between patent collateral circulation and favorable outcome was found. Symptomatic intracranial hemorrhage occurred in 2 patients (5%). CONCLUSIONS AND RELEVANCEThe proportion of patients reaching a favorable outcome in our study is comparable to the IA-treated group of the MR CLEAN trial and better than the results reported in the BASICS registry, suggesting that IA intervention in patients with BAO is an effective and safe treatment modality in daily clinical practice.

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Additional Diagnostic Value of Computed Tomography Perfusion for Detection of Acute Ischemic Stroke in the Posterior Circulation

Cited by 61 publications

References 9 publications

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

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

Safety and Outcome of Intra-Arterial Treatment for Basilar Artery Occlusion

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