Comparison of Perfusion Computed Tomography and Computed Tomography Angiography Source Images With Perfusion-Weighted Imaging and Diffusion-Weighted Imaging in Patients With Acute Stroke of Less Than 6 Hours’ Duration

Abstract

Background and Purpose-We aimed to determine the diagnostic value of perfusion computed tomography (PCT) and CT angiography (CTA) including CTA source images (CTA-SI) in comparison with perfusion-weighted magnetic resonance imaging (MRI) (PWI) and diffusion-weighted MRI (DWI) in acute stroke Ͻ6 hours. Methods-Noncontrast-enhanced CT, PCT, CTA, stroke MRI, including PWI and DWI, and MR angiography (MRA), were performed in patients with symptoms of acute stroke lasting Ͻ6 hours. We analyzed ischemic lesion volumes on patients' arrival as shown on NECT, PCT, CTA-SI, DWI, and PWI (Wilcoxon, Spearman, Bland-Altman) and compared them to the infarct extent as shown on day 5 NECT. Results-Twenty-two stroke patients underwent CT and MRI scanning within 6 hours. PCT time to peak (PCT-TTP) volumes did not differ from PWI-TTP (Pϭ0.686 for patients who did not undergo thrombolysis/Pϭ0.328 for patients who underwent thrombolysis), nor did PCT cerebral blood volume (PCT-CBV) differ from PWI-CBV (Pϭ0. Pϭ0.0047, rϭ1.0/Pϭ0.0046, rϭ0.819). Conclusions-In hyperacute stroke, the combination of PCT and CTA can render important diagnostic information regarding the infarct extent and the perfusion deficit. Lesions on PCT-TTP and PCT-CBV do not differ from lesions on PWI-TTP and PWI-CBV; lesions on CTA source images do not differ from lesions on DWI. The combination of noncontrast-enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA) can render additional information within Ͻ15 minutes and may help in therapeutic decision-making if PWI and DWI are not available or cannot be performed on specific patients.

Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease

“…Articles in category 2 correlated perfusion imaging findings with clinical outcome, and those in category 3 compared perfusion imaging findings with final size of the infarct on subsequent imaging studies. 5,6,14,19,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Articles in category 2 and category 3 served the dual functions of validating perfusion imaging as a test and providing information that could be used for prognosis but not use of perfusion imaging in decision making.…”

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

“…7,8 Areas of hypoattenuation on CTA source images (CTASI) delineate regions of brain tissue with ischemic damage. 8,9 Applied on the Alberta Stroke Program Early CT Score (ASPECTS), CTASI has improved the prediction of final infarct size and clinical outcome compared to NCCT. 7 CTA is frequently used in the assessment of patients with suspected basilar artery occlusion and provides excellent information on vascular status.…”

Acute Ischemic Stroke Management Review for the Hospitalist

“…It has 100% sensitivity and 82-100% specificity for identifying occlusions (46,(55)(56)(57). It is also superior to a carotid ultrasound in differentiating high grade carotid stenosis from an occlusion (58).…”