Role of whole-brain computed tomography perfusion in head injury patients to predict outcome

To derive the reperfusion index best predicting clinical outcome of ischemic stroke patients, we retrospectively analysed the acute and 24-h computed tomography perfusion data of 116 patients, collected from two centres equipped with whole-brain computed tomography perfusion. Reperfusion index was defined by the percentage of the ischemic region reperfused from acute to 24-h computed tomography perfusion. Recanalization was graded by arterial occlusive lesion system. Receiver operator characteristic analysis was performed to assess the prognostic value of reperfusion and recanalization in predicting good clinical outcome, defined as modified Rankin Score of 0–2 at 90 days. Among previous reported reperfusion measurements, reperfusion of the Tmax>6 s region resulted in higher prognostic value than recanalization at predicting good clinical outcome (area under the curve = 0.88 and 0.74, respectively, p = 0.002). Successful reperfusion of the Tmax>6 s region (≥60%) had 89% sensitivity and 78% specificity in predicting good clinical outcome. A reperfusion index defined by Tmax>2 s or by mean transit time>145% had much lower area under the curve in comparison to Tmax>6 s measurement (p < 0.001 and p = 0.003, respectively), and had no significant difference to recanalization at predicting clinical outcome (p = 0.58 and 0.63, respectively). In conclusion, reperfusion index calculated by Tmax>6 s is a stronger predictor of clinical outcome than recanalization or other reperfusion measures.

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Diagnostic accuracy of whole-brain computed tomography perfusion for detection of ischemic stroke in patients with mild neurological symptoms

The Neuroradiology Journal ◽

10.1177/1971400918770898 ◽

2018 ◽

Vol 31 (5) ◽

pp. 464-472 ◽

Cited By ~ 1

Author(s):

Robert A Frank ◽

Santanu Chakraborty ◽

Trevor McGrath ◽

Alexander Mungham ◽

James Ross ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Whole Brain ◽

Computed Tomography Perfusion ◽

Brain Computed Tomography ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging

Mild and minor acute neurological symptoms may lead to diagnostic uncertainty, resulting in a heterogeneous group of patients with true ischemic events and stroke mimics with a potential for poor outcomes. More than half of ischemic stroke patients present as minor strokes (National Institutes of Health Stroke Scale score <6). Whole-brain computed tomography perfusion can be used as a diagnostic test for minor stroke, offering a potential method of reducing diagnostic uncertainty in these patients. We hypothesize that whole-brain computed tomography perfusion imaging features could accurately predict infarction in patients with minor neurological deficits. This retrospective chart review enrolled consecutive patients suspected of acute ischemic stroke with a National Institutes of Health Stroke Scale score <6, who underwent whole-brain computed tomography perfusion and follow-up diffusion-weighted magnetic resonance imaging at our institution. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for whole-brain computed tomography perfusion, using follow-up diffusion-weighted magnetic resonance imaging as a reference standard. A total of 524 patients (mean age: 67 years; range: 17–96 years; 56% men) met the inclusion criteria. Patients were excluded for non-diagnostic ( n = 25) or missing maps ( n = 8) scans, non-ischemic findings ( n = 7), and lack of follow-up magnetic resonance imaging ( n = 336). The final analysis included 148 patients who underwent diffusion-weighted magnetic resonance imaging. Whole-brain computed tomography perfusion has a sensitivity of 0.57 (95% CI: 0.45–0.69) and a specificity of 0.82 (95% CI: 0.71–0.90). The positive and negative predictive values and positive and negative likelihood ratios were 75%, 67%, 3.09, and 0.53, respectively. Our analysis suggests that although whole-brain computed tomography perfusion may offer some value as an adjunctive test for improving confidence in offering stroke treatment, it is not sufficiently sensitive or specific to accurately predict cerebral infarcts in patients with minor neurological symptoms.

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Assessment of Tracer Delay Effect in Whole-Brain Computed Tomography Perfusion

Journal of Computer Assisted Tomography ◽

10.1097/rct.0b013e318280a465 ◽

2013 ◽

Vol 37 (2) ◽

pp. 222-232 ◽

Cited By ~ 2

Author(s):

Eric H. Hanson ◽

Cayce J. Roach ◽

Kirtly J. Day ◽

Kaushik Ghosh ◽

Keith R. Peters ◽

...

Keyword(s):

Computed Tomography ◽

Delay Effect ◽

Whole Brain ◽

Computed Tomography Perfusion ◽

Brain Computed Tomography

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The role of computed tomography perfusion in the diagnosis of brain ischaemic stroke

Orvosi Hetilap ◽

10.1556/oh.2008.28323 ◽

2008 ◽

Vol 149 (23) ◽

pp. 1059-1065 ◽

Cited By ~ 1

Author(s):

Szabolcs Halász ◽

Tamás Puskás

Keyword(s):

Computed Tomography ◽

Ischaemic Stroke ◽

Spiral Ct ◽

Computed Tomography Perfusion

A többszeletes spirál-CT-berendezések széles körű alkalmazása és a perfúziós szoftverek bevezetése lehetővé tette az agyi véráramlás CT-vizsgálatát. Cél és módszerek: A szerzők ismertetik az agyi perfúziós CT-vizsgálatok elvét, technikáját, amelyet az elmúlt másfél évben 96 betegükön végzett vizsgálatuk tapasztalataival egészítenek ki. A folyamatos technikai fejlődés eredményeként a közeljövőben lehetővé válik a teljes agy perfúziós CT-vizsgálata. Következtetések: Az agy perfúziós CT-vizsgálata gyors, viszonylag olcsó és a stroke kórismézésében pontos diagnózist eredményez.

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