title: CT Perfusion in Acute Lacunar Stroke: Detection Capabilities Based on Infarct Location.
abstract: Recent studies demonstrated superiority of CTP to NCCT/CTA at detecting lacunar infarcts. This study aimed to assess CTP's capability to identify lacunae in different intracranial regions.
  
  
  
  Over 5.5 years, 1085 CTP examinations were retrospectively reviewed in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Patients had infarcts ≤2 cm or no acute infarct on DWI; patients with concomitant infarcts >2 cm on DWI were excluded. CTP postprocessing was automated by a delay-corrected algorithm. Three blinded reviewers were given patient NIHSS scores and symptoms; infarcts were recorded based on NCCT/CTA, CTP (CBF, CBV, MTT, and TTP), and DWI.
  
  
  
  One hundred thirteen patients met inclusion criteria (53.1% female). On DWI, lacunar infarcts were present in 37 of 113 (32.7%), and absent in 76 of 113 (67.3%). On CTP, lacunar infarcts typically appeared as abnormalities larger than infarct size on DWI. Interobserver κ for CTP ranged from 0.38 (CBF) (P < .0001) to 0.66 (TTP) (P < .0001); interobserver κ for DWI was 0.88 (P < 0.0001). In all intracranial regions, sensitivity of CTP ranged from 18.9% (CBV) to 48.7% (TTP); specificity ranged from 97.4% (CBF and TTP) to 98.7% (CBV and MTT). CTP's sensitivity was highest in the subcortical white matter with or without cortical involvement (21.7%-65.2%) followed by periventricular white matter (12.5%-37.5%); sensitivity in the thalami or basal ganglia was 0%.
  
  
  
  CTP has low sensitivity and high specificity in identifying lacunar infarcts. Sensitivity is highest in the subcortical white matter with or without cortical involvement, but limited in the basal ganglia and thalami.
authors.affiliation: From the Department of Radiology (J.C.B., S.P., S.M., A.M.M.) benso905@umn.edu.
authors.forename: J C
authors.identifier: 0000-0002-4038-5422
authors.initials: JC
authors.lastname: Benson
authors.affiliation: From the Department of Radiology (J.C.B., S.P., S.M., A.M.M.).
authors.forename: S
authors.identifier: 0000-0003-4628-0370
authors.initials: S
authors.lastname: Payabvash
authors.affiliation: From the Department of Radiology (J.C.B., S.P., S.M., A.M.M.).
authors.forename: S
authors.identifier: 0000-0001-7458-3964
authors.initials: S
authors.lastname: Mortazavi
authors.affiliation: Clinical and Translational Science Institute (L.Z., P.S.), University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: L
authors.identifier: 0000-0002-3067-305X
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Clinical and Translational Science Institute (L.Z., P.S.), University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: P
authors.identifier: 0000-0002-7779-2603
authors.initials: P
authors.lastname: Salazar
authors.affiliation: Vital Images, a division of Toshiba Medical (B.H., M.O.), Minnetonka, Minnesota.|Department of Radiology (B.H., M.O.), Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: B
authors.identifier: 0000-0002-8010-4154
authors.initials: B
authors.lastname: Hoffman
authors.affiliation: Vital Images, a division of Toshiba Medical (B.H., M.O.), Minnetonka, Minnesota.|Department of Radiology (B.H., M.O.), Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: M
authors.identifier: 0000-0002-9942-4094
authors.initials: M
authors.lastname: Oswood
authors.affiliation: From the Department of Radiology (J.C.B., S.P., S.M., A.M.M.).
authors.forename: A M
authors.identifier: 0000-0003-2530-5970
authors.initials: AM
authors.lastname: McKinney
mesh_terms: D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D059409:Stroke, Lacunar / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods