title: Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke.
abstract: Computed tomography perfusion (CTP) has a high diagnostic value in the detection of acute ischemic stroke in the anterior circulation. However, the diagnostic value in suspected posterior circulation (PC) stroke is uncertain, and whole brain volume perfusion is not yet in widespread use. We therefore studied the additional value of whole brain volume perfusion to non-contrast CT (NCCT) and CT angiography source images (CTA-SI) for infarct detection in patients with suspected acute ischemic PC stroke.
  
  
  
  This is a retrospective review of patients with suspected stroke in the PC in a database of our stroke center (n = 3,011) who underwent NCCT, CTA and CTP within 9 h after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and pc-ASPECTS locations of ischemia. Three imaging models - A (NCCT), B (NCCT + CTA-SI) and C (NCCT + CTA-SI + CTP) - were compared with regard to the misclassification rate relative to gold standard (infarction in follow-up imaging) using the McNemar's test.
  
  
  
  Of 3,011 stroke patients, 267 patients had a suspected stroke in the PC and 188 patients (70.4%) evidenced a PC infarct on follow-up imaging. The sensitivity of Model C (76.6%) was higher compared with that of Model A (21.3%) and Model B (43.6%). CTP detected significantly more ischemic lesions, especially in the cerebellum, posterior cerebral artery territory and thalami.
  
  
  
  Our findings in a large cohort of consecutive patients show that CTP detects significantly more ischemic strokes in the PC than CTA and NCCT alone.
authors.affiliation: Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sporns
authors.forename: Rene
authors.initials: R
authors.lastname: Schmidt
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.forename: André
authors.initials: A
authors.lastname: Kemmling
authors.forename: Ralf
authors.initials: R
authors.lastname: Dittrich
authors.forename: Tarek
authors.initials: T
authors.lastname: Zoubi
authors.forename: Philipp
authors.initials: P
authors.lastname: Heermann
authors.forename: Christian
authors.initials: C
authors.lastname: Cnyrim
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schwindt
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
authors.forename: Uta
authors.initials: U
authors.lastname: Hanning
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D003287:Contrast Media / Q000008:administration & dosage; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D061330:Multidetector Computed Tomography; D055420:Perfusion Imaging / Q000379:methods*; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide