Diagnostic accuracy of whole-brain CT perfusion in the detection of acute infratentorial infarctions

Bollwein, Christine; Plate, Andreas; Sommer, Wieland H.; Thierfelder, Kolja M.; Janssen, Hendrik; Reiser, Maximilian; Straube, Andreas; Baumgarten, Louisa von

doi:10.1007/s00234-016-1743-5

Cited by 14 publications

(27 citation statements)

References 33 publications

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“…PCT images showing no alterations in the same location in at least two visually evaluated perfusion parameter maps neither in automatic maps were considered negative [5].…”

Section: Ncct and Ctp Image Analysismentioning

confidence: 99%

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

“…Brain imaging plays a key role in the evaluation of patients suspected of ischaemic stroke allowing to reach a confident diagnosis of infratentorial stroke [5,12]. MRI with DWI represents the diagnostic gold standard for the detection of ischaemic lesions in the PC territories [4,5]. However, in many institutions, CT is more readily accessible in the acute phase and less time consuming than MRI being also helpful if MRI is contraindicated or unavailable [1,4,5].…”

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

“…MRI with DWI represents the diagnostic gold standard for the detection of ischaemic lesions in the PC territories [4,5]. However, in many institutions, CT is more readily accessible in the acute phase and less time consuming than MRI being also helpful if MRI is contraindicated or unavailable [1,4,5]. CTP has gained widespread application thanks to its accessibility, proved higher sensitivity and accuracy than NCCT alone in detecting acute ischaemic changes also in PC territories [3,5,12,17].…”

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

“…Posterior circulation (PC) stroke accounts for 20-25% of ischaemic strokes and is characterised by a wide range of clinical features that make its clinical diagnosis challenging [1][2][3][4][5][6][7][8][9][10][11][12]. In emergency setting, dynamic CT perfusion (CTP) has been introduced as a particularly useful technique after noncontrast CT (NCCT) given its easy application, reproducibility of quantitative assessment, prompt availability, low cost and tolerability [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

et al. 2020

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Purpose To compare the diagnostic accuracy (ACC) in the detection of acute posterior circulation strokes between qualitative evaluation of software-generated colour maps and automatic assessment of CT perfusion (CTP) parameters. Methods Were retrospectively collected 50 patients suspected of acute posterior circulation stroke who underwent to CTP (GE "Lightspeed", 64 slices) within 24 h after symptom onset between January 2016 and December 2018. The Posterior circulation-Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was used for quantifying the extent of ischaemic areas on non-contrast (NC)CT and colour-coded maps generated by CTP4 (GE) and RAPID (iSchemia View) software. Final pc-ASPECTS was calculated on follow-up NCCT and/or MRI (Philips Intera 3.0 T or Philips Achieva Ingenia 1.5 T). RAPID software also elaborated automatic quantitative mismatch maps. Results By qualitative evaluation of colour-coded maps, MTT-CTP4D and Tmax-RAPID showed the highest sensitivity (SE) (88.6% and 90.9%, respectively) and ACC (84% and 88%, respectively) compared with the other perfusion parameters (CBV, CBF). Baseline NCCT and CBF provided by RAPID quantitative perfusion mismatch maps had the lowest SE (29.6% and 6.8%, respectively) and ACC (38% and 18%, respectively). CBF and Tmax assessment provided by quantitative RAPID perfusion mismatch maps showed significant lower SE and ACC than qualitative evaluation. No significant differences were found between the pc-ASPECTSs assessed on colour-coded MTT and Tmax maps neither between the scores assessed on colourcoded CBV-CTP4D and CBF-RAPID maps. Conclusion Qualitative analysis of colour-coded maps resulted more sensitive and accurate in the detection of ischaemic changes than automatic quantitative analysis.

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“…PCT images showing no alterations in the same location in at least two visually evaluated perfusion parameter maps neither in automatic maps were considered negative [5].…”

Section: Ncct and Ctp Image Analysismentioning

confidence: 99%

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

Section: Ischaemic Lesion Detectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

et al. 2020

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Mechanical thrombectomy for acute posterior cerebral artery stroke; Feasibility and predictors of outcome

et al. 2022

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Detection of impending perfusion deficits by intraoperative computed tomography (iCT) in aneurysm surgery of the anterior circulation

et al. 2021

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Background The aim of our study was to evaluate the additional benefit of intraoperative computed tomography (iCT), intraoperative computed tomography angiography (iCTA), and intraoperative computed tomography perfusion (iCTP) in the intraoperative detection of impending ischemia to established methods (indocyanine green videoangiography (ICGVA), microDoppler, intraoperative neuromonitoring (IONM)) for initiating timely therapeutic measures. Methods Patients with primary aneurysms of the anterior circulation between October 2016 and December 2019 were included. Data of iCT modalities compared to other techniques (ICGVA, microDoppler, IONM) was recorded with emphasis on resulting operative conclusions leading to inspection of clip position, repositioning, or immediate initiation of conservative treatment strategies. Additional variables analyzed included patient demographics, aneurysm-specific characteristics, and clinical outcome. Results Of 194 consecutive patients, 93 patients with 100 aneurysms received iCT imaging. While IONM and ICGVA were normal, an altered vessel patency in iCTA was detected in 5 (5.4%) and a mismatch in iCTP in 7 patients (7.5%). Repositioning was considered appropriate in 2 patients (2.2%), where immediate improvement in iCTP could be documented. In a further 5 cases (5.4%), intensified conservative therapy was immediately initiated treating the reduced CBP as clip repositioning was not considered causal. In terms of clinical outcome at last FU, mRS0 was achieved in 85 (91.4%) and mRS1-2 in 7 (7.5%) and remained mRS4 in one patient with SAH (1.1%). Conclusions Especially iCTP can reveal signs of impending ischemia in selected cases and enable the surgeon to promptly initiate therapeutic measures such as clip repositioning or intraoperative onset of maximum conservative treatment, while established tools might fail to detect those intraoperative pathologic changes.

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Diagnostic accuracy of whole-brain CT perfusion in the detection of acute infratentorial infarctions

Abstract: The detection of infratentorial infarctions can be improved by assessing WB-CTP as part of the multimodal stroke workup. However, it remains a diagnostic challenge, especially small volume infarctions in the brainstem are likely to be missed.

Cited by 14 publications

References 33 publications

Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke

Mechanical thrombectomy for acute posterior cerebral artery stroke; Feasibility and predictors of outcome

Detection of impending perfusion deficits by intraoperative computed tomography (iCT) in aneurysm surgery of the anterior circulation

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