Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke
Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke
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DOI：
10.1159/000443618
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发表时间：
2016-01-01
影响因子：
2.9
通讯作者：
Hanning, Uta
中科院分区：
文献类型：
--
作者：
Sporns, Peter;Schmidt, Rene;Hanning, Uta
背景与目的：计算机断层扫描灌注（CTP）对前循环急性缺血性脑卒中的检测具有较高的诊断价值。然而，对疑似后循环卒中的诊断价值尚不确定，全脑容量灌注尚未广泛应用。因此，我们研究了全脑容量灌注对疑似急性缺血性脑卒中患者的非对比CT （NCCT）和CT血管造影源图像（CTA-SI）检测梗死的附加价值。方法：回顾性分析我院卒中中心数据库中疑似卒中的PC患者（n = 3011），这些患者在卒中发作后9小时内接受了NCCT、CTA和CTP治疗，并进行了CT或MRI随访。图像评估缺血的征象和pc-ASPECTS位置。采用McNemar试验比较A （NCCT）、B （NCCT + CTA-SI）和C （NCCT + CTA-SI + CTP）三种成像模型相对于金标准（随访成像中的梗死）的误分类率。结果：在3011例脑卒中患者中，267例患者在PC区疑似脑卒中，188例患者（70.4%）在随访成像中证实PC区梗死。C模型的敏感性（76.6%）高于A模型（21.3%）和B模型（43.6%）。CTP检测到更多的缺血性病变，特别是在小脑、大脑后动脉区域和丘脑。结论：我们在一项连续患者的大队列研究中发现，CTP在PC中检测到的缺血性卒中明显多于CTA和NCCT。(C) 2016 S. Karger AG，巴塞尔
Background and Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. (C) 2016 S. Karger AG, Basel