title: Perfusion Deficits and Mismatch in Patients with Acute Lacunar Infarcts Studied with Whole-Brain CT Perfusion.
abstract: OBJECTIVE
  The incidence and significance of perfusion abnormalities on brain imaging in patients with lacunar infarct are controversial. We studied the diagnostic yield of CTP and the type of perfusion abnormalities in patients presenting with a lacunar syndrome and in those with MR imaging-confirmed lacunar infarcts.
  
  
  METHODS
  A cohort of 33 patients with lacunar syndrome underwent whole-brain CTP on admission. Twenty-eight patients had an acute ischemic lesion at follow-up MR imaging; 16 were classified as lacunar infarcts. Two independent readers evaluated NCCT and CTP to compare their diagnostic yield. In patients with DWI-confirmed lacunar infarcts and visible deficits on CTP, the presence of mismatch tissue was measured by using different perfusion thresholds.
  
  
  RESULTS
  The symptomatic acute lesion was seen on CTP in 50% of patients presenting with a lacunar syndrome compared with only 17% on NCCT, and in 62% on CTP compared with 19% on NCCT, respectively, in patients with DWI-confirmed lacunar infarcts. CTP was more sensitive in supratentorial than in infratentorial lesions. In the nonblinded analysis, a perfusion deficit was observed in 12/16 patients with DWI-confirmed lacunar infarcts. The proportion of mismatch tissue was similar in patients with lacunar infarcts or nonlacunar strokes (32% versus 36%, P = .734).
  
  
  CONCLUSIONS
  Whole-brain CTP is superior to NCCT in identifying small ischemic lesions, including lacunar infarcts, in patients presenting with a lacunar syndrome. Perfusion deficits and mismatch are frequent in lacunar infarcts, but larger studies are warranted to elucidate the clinical significance of these CTP findings.
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.).
authors.forename: S
authors.initials: S
authors.lastname: Rudilosso
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain xurra@clinic.cat.
authors.forename: X
authors.initials: X
authors.lastname: Urra
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: San Román
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.).
authors.forename: C
authors.initials: C
authors.lastname: Laredo
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: López-Rueda
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Amaro
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Oleaga
authors.affiliation: From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain Department of Medicine (Á.C.), School of Medicine, University of Barcelona, Barcelona. Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Chamorro
mesh_terms: D000208:Acute Disease; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D012039:Regional Blood Flow; D059409:Stroke, Lacunar / Q000473:pathology* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*