title: Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke.
abstract: BACKGROUND
  Cerebral cortical ischemia is a risk factor for post-stroke seizures. However, the optimal imaging method is unclear. We investigated CT perfusion (CTP) in detecting cortical ischemia and its correlation with post-stroke seizures compared with non-contrast CT (NCCT).
  
  
  METHODS
  We included patients with acute ischemic stroke admitted to the Royal Melbourne Hospital between 2009 and 2014. Post-stroke seizure information was collected. Cortical involvement was determined on acute NCCT and CTP (T max, cerebral blood volume [CBV], and cerebral blood flow [CBF]). The association between cortical involvement detected by different imaging modalities and post-stroke seizures was examined.
  
  
  RESULTS
  Three-hundred fifty-two patients were included for analysis. Fifty-nine percent were male, and median age was 73 years (inter-quartile range 61-82). Follow-up was available for 96 %; median follow-up duration was 377 days (inter-quartile range 91-1018 days). Thirteen patients had post-stroke seizures (3.9 %). Cortical involvement was significantly associated with post-stroke seizures across all modalities. CBV had the highest hazard ratio (11.3, 95 % confidence interval (CI) 1.1-41.2), followed by NCCT (5.3, 95 % CI 1.5-18.0) and CBF (4.2, 95 % CI 1.1-15.2). Sensitivity was highest for T max (100 %), followed by CBV and CBF (both 76.9 %) and NCCT (63.6 %). Specificity was highest for CBV (77.8 %), then NCCT (75.6 %), CBF (54.0 %), and T max (29.1 %). Receiver-operating characteristic area under the curve was significantly different between imaging modalities (p < 0.001), CBV 0.77, NCCT 0.70, CBF 0.65, and T max 0.65.
  
  
  CONCLUSIONS
  CTP may improve sensitivity and specificity of cortical involvement for post-stroke seizures compared to NCCT.
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
authors.forename: Miriam
authors.initials: M
authors.lastname: Koome
authors.affiliation: Florey Neuroscience Institutes, Austin Health, University of Melbourne, Melbourne, Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.|School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Ziyuan
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.|First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China.
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Australia.
authors.forename: Jillian
authors.initials: J
authors.lastname: Naylor
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
authors.forename: Arthur
authors.initials: A
authors.lastname: Thevathasan
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia. bernard.yan@mh.org.au.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
authors.affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia. patrick.kwan@unimelb.edu.au.|Department of Medicine, The University of Melbourne, Melbourne, Australia. patrick.kwan@unimelb.edu.au.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012640:Seizures / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: CT perfusion; Ischemic stroke; Non-contrast CT; Post-stroke epilepsy; Seizures