Improvement of Sensitivity and Interrater Reliability to Detect Acute Stroke by Dynamic Perfusion Computed Tomography and Computed Tomography Angiography

Scharf, Johann; Brockmann, Marc A.; Daffertshofer, Michael; Diepers, Michael; Neumaier-Probst, Eva; Weiss, Christel; Paschke, Tilmann; Groden, Christoph

doi:10.1097/01.rct.0000187417.15321.ca

Cited by 39 publications

(26 citation statements)

References 18 publications

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“…Mean times for processing and interpreting CTA and CTP data have been found to be 15 min in experienced hands [13], which makes this technique a reasonable alternative to magnetic resonance in the setting of acute stroke. Different studies found, that CTA and CTP provide an effective add-on to standard CT in acute stroke imaging by significantly increasing the sensitivity and reliability of infarct detection [14][15][16][17]. In a recent study it has been furthermore argued, that CTP-derived CBF and CBV can be used to differentiate between penumbra and infarcted gray matter in stroke [18], however, larger studies are still needed to evaluate, whether CTP data will allow differentiation of irreversibly and reversibly damaged brain tissue to a similar extent as magnetic resonance imaging (MRI) does.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Dynamische CT-Angiographie und CT-Perfusion mit einem 320-Zeilen-CT. Protokoll und aktuelle klinische Anwendungen

et al. 2009

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The aim of this study is to report the authors' initial clinical experience of a 320-detector row computed tomography (CT) scanner in cerebrovascular disorders. Volumetric CT using the full 160-mm width of the 320 detector rows enables full brain coverage in a single rotation that allows for combined time-resolved whole-brain perfusion and four-dimensional CT angiography (CTA). The protocol for the combined dynamic CTA and CT perfusion (CTP) is presented, and its potential applications in stroke, stenoocclusive disease, arteriovenous malformations and dural shunts are reviewed based on clinical examples. The combined CTA/CTP data can provide visualization of dynamic flow and perfusion as well as motion of an entire volume at very short time intervals which is of importance in a variety of pathologies with altered cerebral hemodynamics. The broad coverage enabled by 320 detector rows offers z-axis coverage allowing for whole-brain perfusion and subtracted dynamic angiography of the entire intracranial circulation.

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Section: Clinical Applicationsmentioning

confidence: 99%

Dynamische CT-Angiographie und CT-Perfusion mit einem 320-Zeilen-CT. Protokoll und aktuelle klinische Anwendungen

et al. 2009

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“…In the current 3-hour therapeutic window for use of intravenous tissue plasminogen activator (tPA), NCCT is performed primarily to exclude intracerebral hemorrhage and ischemic stroke mimics. There have been several reports of improved accuracy using dynamic CT perfusion (CTP) for hemispheric infarcts in the first 12 h [5, 6] and 6 h [7, 8] after symptom onset. However, the use of intravenous tPA outside the 3-hour window remains a contraindication to date.…”

Section: Introductionmentioning

confidence: 99%

Perfusion CT Improves Diagnostic Accuracy for Hyperacute Ischemic Stroke in the 3-Hour Window: Study of 100 Patients with Diffusion MRI Confirmation

Lin¹,

Kinh²,

Ong³

et al. 2009

Cerebrovasc Dis

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Purpose: Conventional noncontrast CT (NCCT) is insensitive to hyperacute cerebral infarction in the first 3 h. Our aim was to determine if CT perfusion (CTP) can improve diagnostic accuracy over NCCT for patients presenting with stroke symptoms in the 3-hour window. Methods: Consecutive patients presenting to our emergency department with symptoms of ischemic stroke <3 h old and receiving NCCT and CTP as part of their triage evaluation were retrospectively reviewed. Patients with follow-up diffusion-weighted MRI (DWI) <7 days from ictus were included. Two readers rated the NCCT and CTP for evidence of acute infarct and its vascular territory. CTP selectively covered 24 mm of brain centered at the basal ganglia with low relative cerebral blood volume in a region of low cerebral blood flow or elevated time to peak as the operational definition for infarction. A third reader rated all follow-up DWI for acute infarct and its vascular territory as the reference standard. Sensitivity, specificity, and predictive values were calculated. An exact McNemar test and generalized estimating equations from a binary logistic regression model were used to assess the difference in detection rates between modalities. A two-sided p value <0.05 was considered significant. Results: 100 patients were included. Sixty-five (65%) patients had follow-up DWI confirmation of acute infarct. NCCT revealed 17 (26.2%) acute infarcts without false positives. CTP revealed 42 (64.6%) acute infarcts with one false positive. Of the 23 infarcts missed on CTP, 10 (43.5%) were outside the volume of coverage while the remaining 13 (56.5%) were small cortical or lacunar type infarcts (≤15 mm in size). CTP was significantly more sensitive (64.6 vs. 26.2%, p < 0.0001) and accurate (76.0 vs. 52%, p < 0.0001) and had a better negative predictive value (59.6 vs. 42.2%, p = 0.032) than NCCT. Conclusion: In a retrospective cohort of 100 patients with symptoms of hyperacute stroke in the 3-hour window, CTP provided improved sensitivity and accuracy over NCCT.

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“…Multidetector CT angiography (MDCTA) improves the sensitivity and inter-rater reliability of detecting acute stroke 13 . In addition, it is an accurate and powerful noninvasive tool for assessing carotid artery disease in the setting of hyperacute ischemic stroke, including the detection of atherosclerosis involvement in extra-and intra-cranial vessels.…”

mentioning

confidence: 99%

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

Pacheco¹,

Littig²,

Gagliardi³

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective The potential of computed tomography angiography (CTA) was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours). Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2%) based on both clinical grounds and imaging follow-up (stroke group), with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86%) while artery-to-artery embolization was the most common stroke mechanism (52%). Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

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Improvement of Sensitivity and Interrater Reliability to Detect Acute Stroke by Dynamic Perfusion Computed Tomography and Computed Tomography Angiography

Abstract: Computed tomography perfusion and CTA provide an effective add-on to standard CT in acute stroke imaging by significantly increasing the sensitivity and reliability of infarct detection.

Cited by 39 publications

References 18 publications

Dynamische CT-Angiographie und CT-Perfusion mit einem 320-Zeilen-CT. Protokoll und aktuelle klinische Anwendungen

Dynamische CT-Angiographie und CT-Perfusion mit einem 320-Zeilen-CT. Protokoll und aktuelle klinische Anwendungen

Perfusion CT Improves Diagnostic Accuracy for Hyperacute Ischemic Stroke in the 3-Hour Window: Study of 100 Patients with Diffusion MRI Confirmation

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

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