title: Perfusion-weighted map and perfused blood volume in comparison with CT angiography source imaging in acute ischemic stroke different sides of the same coin?
abstract: OBJECTIVE
  Computed tomography angiography source imaging (CTA-SI) in acute ischemic stroke improves detection rate and estimation of extent of cerebral infarction. This study compared the new components color-coded perfusion weighted map (PWM) and color-coded perfused blood volume (PBV) derived from CTA data with CTA-SI for the visualization of cerebral infarction.
  
  
  METHODS
  Fifty patients (women = 30; mean age = 74.9 ± 13.3 years) underwent nonenhanced computed tomography and CTA for suspected acute ischemic stroke. PWM, PBV, and CTA-SI were reconstructed with identical slice thickness of 1.0 mm with commercial software. Extent of infarction was measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). For statistical analysis, Spearman's R correlation and paired-samples t-test was used. P < .05 was considered significant.
  
  
  RESULTS
  PBV had superior sensitivity for detection of cerebral infarction with 0.88 compared to PWM and CTA-SI with 0.79 and 0.76, respectively. The accuracy of correct diagnosis was superior for PBV with 0.82 compared to PWM and CTA-SI with 0.76, respectively. ASPECTS of PWM and PBV showed strong correlation with CTA-SI with r = 0.903 (P < .001) and r = 0.866 (P < .001), respectively. Mean ASPECTS of CTA-SI (6.24 ± 3.62) revealed no significant difference with PWM (6.26 ± 3.45), but a significant difference with PBV (5.62 ± 3.41; P < .02).
  
  
  CONCLUSIONS
  PWM was equal to CTA-SI in detection of cerebral infarction and estimation of extent of cerebral ischemia. Although PBV was superior to CTA-SI in detection of cerebral infarction, PBV seems to overestimate the extent of critical cerebral ischemia. Therefore, CTA-SI information is not identical to PBV and further clinical evaluation is mandatory.
authors.affiliation: Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Buerke
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wittkamp
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.forename: Peter
authors.initials: P
authors.lastname: Seidensticker
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001811:Blood Volume Determination / Q000379:methods*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*