title: CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke.
abstract: BACKGROUND
  We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging.
  
  
  METHODS
  We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R (2) was assessed to determine the additional value of CTA and CTP.
  
  
  RESULTS
  At follow-up, 612 patients (67.5%) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95% confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95% CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95% CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95% CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R (2) = 0.58) was superior to patient characteristics and non-contrast CT alone (R (2) = 0.44) and to addition of CTA alone (R (2) = 0.55) or CTP alone (R (2) = 0.54; all p < 0.001).
  
  
  CONCLUSIONS
  In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands. T.vanSeeters@umcutrecht.nl.
authors.forename: Tom
authors.initials: T
authors.lastname: van Seeters
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Irene C
authors.initials: IC
authors.lastname: van der Schaaf
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Horsch
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Joris M
authors.initials: JM
authors.lastname: Niesten
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Merel J A
authors.initials: MJ
authors.lastname: Luitse
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jan Albert
authors.initials: JA
authors.lastname: Vos
authors.affiliation: Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.affiliation: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Lucien E M
authors.initials: LE
authors.lastname: Duijm
authors.affiliation: Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Koos
authors.initials: K
authors.lastname: Keizer
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joseph C J
authors.initials: JC
authors.lastname: Bot
authors.affiliation: Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marieke C
authors.initials: MC
authors.lastname: Visser
authors.affiliation: Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: F Oskar H W
authors.initials: FO
authors.lastname: Kesselring
authors.affiliation: Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Hofmeijer
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama À Nijeholt
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: Department of Radiology, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: van Rooij
authors.affiliation: Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Paul L M
authors.initials: PL
authors.lastname: de Kort
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yvo B W E M
authors.initials: YB
authors.lastname: Roos
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Frederick J A
authors.initials: FJ
authors.lastname: Meijer
authors.affiliation: Department of Radiology, St. Franciscus Hospital, Rotterdam, The Netherlands.
authors.forename: C Constantijn
authors.initials: CC
authors.lastname: Pleiter
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: CT angiography; CT perfusion; Infarct volume; Ischemic stroke; Prediction