Diagnostic Accuracy of CT Perfusion Imaging for Detecting Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: The aim of the current study was to determine the sensitivity and specificity of CT perfusion (CTP) for the detection of ischemic strokeby performing a systematic review and meta-analysis of published reports. Methods: We searched PubMed, Embase and the Cochrane library using the terms ‘perfusion computed tomography', ‘ischemic stroke' and synonyms. We included studies that: (1) reported original data, (2) studied the diagnostic value of CTP for detecting ischemic stroke, (3) used MRI-DWI, follow-up MRI or follow-up CT as the reference standard, (4) included at least 10 patients who were suspected of ischemic stroke, and (5) reported the number of true positives, true negatives, false positives and false negatives for the diagnosis of ischemic stroke. Results: Fifteen studies were finally included in the current review with a total of 1,107 patients. A pooled analysis resulted in a sensitivity of 80% (95% confidence interval, CI: 72-86%) and a specificity of 95% (95% CI: 86-98%). Almost two thirds of the false negatives were due to small lacunar infarcts; the remaining false negatives were mostly due to limited coverage. Conclusions: The current systematic review shows that CTP has a high sensitivity and a very high specificity for detecting infarcts.

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

“…3 The additional diagnostic value of CTP compared with NCCT and CTA for posterior circulation stroke has not been analyzed.…”

Perfusion Deficits and Mismatch in Patients with Acute Lacunar Infarcts Studied with Whole-Brain CT Perfusion

“…6 Conflicting results have been reported regarding the presence of perfusion deficits in patients with LI, [7][8][9][10][11] with sensitivities varying from 0% to 68% in studies using MR imaging [12][13][14] and from 17% to 47% with CTP. 15,16 In fact, LI is considered one of the causes of false-negative CTP findings.…”

“…15,16 In fact, LI is considered one of the causes of false-negative CTP findings. 10,11 Some reports suggest that the presence of a perfusion deficit is associated with worse outcome in patients with LIs. 8,13 Regarding the presence of mismatch, a study using perfusion MR imaging did not find a mismatch between perfusion and diffusion sequences in strokes involving perforating arteries, but these results could be explained by the low resolution of their imaging methods.…”

Value of Whole Brain Computed Tomography Perfusion for Predicting Outcome after TIA or Minor Ischemic Stroke

“…CTP has high sensitivity (80%) and specificity (95%) for detecting infarcts, with false-negative findings because of limited spatial resolution (lower sensitivity for small infarcts) or limited coverage. 19 Most institutions still use CT scanners with limited perfusion coverage, which limits its use in clinical practice. With the advent of 320-slice multidetector CT scans with whole brain perfusion coverage, assessment of the complete region of ischemia in supratentorial and infratentorial areas of the brain simultaneously has become possible.…”