Diagnostic accuracy of whole-brain computed tomographic perfusion imaging in small-volume infarctions.
OBJECTIVE
The aims of this study were to determine the diagnostic accuracy of whole-brain computed tomographic perfusion (WB-CTP) in small ischemic brain infarctions and to identify factors influencing the detection rate.


METHODS
Out of a retrospective cohort of 1380 subjects who underwent initial WB-CTP because of suspected stroke, we selected all patients with a supratentorial magnetic resonance imaging-confirmed ischemic infarction with a volume of 8 mL or less. Infratentorial lesions were excluded. The study was designed as a case-control study with a ratio of cases to controls with no infarction in follow-up magnetic resonance imaging of 1:3. Two blinded readers independently evaluated 4 different computed tomographic perfusion parameter data sets per subject with respect to the presence and localization of a perfusion deficit.


RESULTS
A total of 113 subjects met the inclusion criteria for the patient group. Overall, WB-CTP reached a sensitivity of 43.4% and a specificity of 92.9%. Among these, cortical infarctions were detected in 31 (69%) of 49 cases, whereas subcortical infarctions were detected only in 18 (28%) of 64 cases (P < 0.05). Mean final infarction diameter (17.3 mm) and volume (1.9 mL) of infarctions detected on CTP were significantly larger than those of infarctions not detected (12.4 mm and 0.8 mL, respectively; P < 0.001). Time from symptom onset did not differ significantly between infarctions that were detected or those that were not (204 vs 189 minutes; P = 0.75).


CONCLUSIONS
The detection rate of WB-CTP in small infarctions highly depends on infarction localization and final size, whereas time from symptom onset does not seem to influence diagnostic accuracy.
From the *Institute of Clinical Radiology, Departments of †Neurology, and ‡Neuroradiology, and §Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
Kolja M
KM
Thierfelder
Louisa
L
von Baumgarten
Antje C
AC
Löchelt
Felix G
FG
Meinel
Marco
M
Armbruster
Sebastian E
SE
Beyer
Maximilian
M
Patzig
Christian
C
Opherk
Maximilian F
MF
Reiser
Wieland H
WH
Sommer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D020520:Brain Infarction / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*