Additional diagnostic value of computed tomography perfusion for detection of acute ischemic stroke in the posterior circulation.
OBJECTIVE
Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke.


METHODS
Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics.


RESULTS
Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; P(C versus A)<0.001) and B (area under the curve from the receiver operating characteristic curve=0.68; 95% confidence interval, 0.56-0.79; P(C versus B)<0.001).


CONCLUSIONS
CT perfusion has significant additional diagnostic values to noncontrast CT and CT angiography source images for detecting ischemic changes in patients suspected of acute posterior circulation stroke.
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands. e.van.der.hoeven@antoniusziekenhuis.nl.
Erik J R J
EJ
van der Hoeven
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Jan Willem
JW
Dankbaar
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Ale
A
Algra
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Jan Albert
JA
Vos
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Joris M
JM
Niesten
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Tom
T
van Seeters
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Irene C
IC
van der Schaaf
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Wouter J
WJ
Schonewille
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
L Jaap
LJ
Kappelle
From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Birgitta K
BK
Velthuis
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis*; D002531:Cerebellum / Q000473:pathology; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D020769:Posterior Cerebral Artery / Q000473:pathology; D011237:Predictive Value of Tests; D020521:Stroke / Q000175:diagnosis*; D013788:Thalamus / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards
brain infarction; multidetector computed tomography