Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke.
Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke.
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发表时间：
2005
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通讯作者：
M. Wintermark;N. Fischbein;Wade S. Smith;N. Ko;M. Quist;W. Dillon
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作者：
M. Wintermark;N. Fischbein;Wade S. Smith;N. Ko;M. Quist;W. Dillon
背景与目的采用反褶积技术的动态灌注CT （PCT）可生成峰值时间（TTP）、平均传递时间（MTT）、区域脑血流量（rCBF）和区域脑血容量（rCBV）图，并可自动绘制梗死区和半暗区图。我们确定了这些图在疑似急性脑卒中患者中的准确性。方法46例患者行非增强CT和动态PCT，随访CT或MR成像。两名观察员回顾了未增强的卒中征象研究，并阅读了TTP、MTT、rCBF和rCBV异常的PCT图。比较敏感性、特异性、准确性和观察者间一致性（Wilcoxon试验）。根据先前报道的方法回顾非增强CT和PCT数据以确定脑卒中范围。测定了计算机地图检测缺血及其程度的敏感性、特异性和准确性。结果与非增强CT相比，PCT图对脑卒中的检测准确率显著提高（75.7-86.0%比66.2%,P < 0.01）， MTT图的敏感性显著提高（77.6%比69.2%,P < 0.01）， rCBF和rCBV图的特异性显著提高（分别为90.9%和92.7%,P < 0.01）。关于脑卒中范围，PCT图谱明显比非增强CT更敏感（高达94.4% vs. 42.9%; P < 0.01），观察者之间的一致性更高（高达0.763）。计算机地图检测缺血的敏感性、特异性和准确性分别为68.2%、92.3%和88.1%，显示缺血程度的敏感性、特异性和准确性分别为72.2%、91.8%和87.9%。结论动态PCT图对脑半球脑卒中的诊断精度高于非增强CT。尽管空间覆盖范围有限，但PCT在评估脑卒中程度方面具有很高的可靠性。
BACKGROUND AND PURPOSE Dynamic perfusion CT (PCT) with deconvolution produces maps of time-to-peak (TTP), mean transit time (MTT), regional cerebral blood flow (rCBF), and regional cerebral blood volume (rCBV), with a computerized automated map of the infarct and penumbra. We determined the accuracy of these maps in patients with suspected acute hemispheric stroke. METHODS Forty-six patients underwent nonenhanced CT and dynamic PCT, with follow-up CT or MR imaging. Two observers reviewed the nonenhanced studies for signs of stroke and read the PCT maps for TTP, MTT, rCBF, and rCBV abnormalities. Sensitivity, specificity, accuracy, and interobserver agreement were compared (Wilcoxon tests). Nonenhanced CT and PCT data were reviewed for stroke extent according to previously reported methods. Sensitivity, specificity, and accuracy of the computerized maps in detecting ischemia and its extent were determined. RESULTS Compared with nonenhanced CT, PCT maps were significantly more accurate in detecting stroke (75.7-86.0% vs. 66.2%; P <.01), MTT maps were significantly more sensitive (77.6% vs. 69.2%; P <.01), and rCBF and rCBV maps were significantly more specific (90.9% and 92.7%, respectively, vs. 65.0%; P <.01). Regarding stroke extent, PCT maps were significantly more sensitive than nonenhanced CT (up to 94.4% vs. 42.9%; P <.01) and had higher interobserver agreement (up to 0.763). For the computerized map, sensitivity, specificity, and accuracy, respectively, were 68.2%, 92.3%, and 88.1% in detecting ischemia and 72.2%, 91.8%, and 87.9% in showing the extent. CONCLUSION Dynamic PCT maps are more accurate than nonenhanced CT in detecting hemispheric strokes. Despite limited spatial coverage, PCT is highly reliable to assess the stroke extent.