Diagnosing acute lacunar infarction using CT perfusion

Wenjie Cao; Nawaf Yassi; Gagan Sharma; Bernard Yan; Patricia M Desmond; Stephen M Davis; Bruce C V Campbell

doi:10.1016/j.jocn.2016.01.001

Diagnosing acute lacunar infarction using CT perfusion

J Clin Neurosci. 2016 Jul:29:70-2. doi: 10.1016/j.jocn.2016.01.001. Epub 2016 Feb 15.

Authors

Wenjie Cao¹, Nawaf Yassi², Gagan Sharma³, Bernard Yan², Patricia M Desmond³, Stephen M Davis², Bruce C V Campbell⁴

Affiliations

¹ Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
³ Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia. Electronic address: bruce.campbell@mh.org.au.

PMID: 26899357
DOI: 10.1016/j.jocn.2016.01.001

Abstract

The value of CT perfusion (CTP) in detecting acute lacunar infarcts (LACI) has not been well established. We tested the sensitivity of CTP for LACI. CTP maps of consecutive stroke patients from 2009-2013 were examined. MRI diffusion imaging was used to identify those with LACI. Two stroke neurologists independently evaluated the CTP maps for evidence of a perfusion lesion in a deep perforating artery territory. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to maximum (Tmax) maps were first examined in isolation and then in combination. Inter-observer agreement was measured using Cohen's κ. The lesions identified were later confirmed against the diffusion MRI reference and the sensitivity and specificity of CTP maps calculated. A total of 63 patient scans were analysed. There were 32 patients with MRI-confirmed LACI within the coverage of CTP; 18 in the striatum, 10 thalamic, and four in the corona radiata. Another 31 patients had normal MRI. Inter-rater agreement was good (κ=0.83). Sensitivity (blinded consensus) was highest for MTT (56.2%) compared to Tmax (25%, p<0.001), CBV (9.3%, p=0.021) and CBF (43.7%, p<0.001). MTT maps enable detection of a significant proportion of LACI using CTP.

Keywords: Acute stroke; CT perfusion; Lacunar infarction; MTT.

MeSH terms

Aged
Aged, 80 and over
Cerebrovascular Circulation / physiology*
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Perfusion Imaging / methods*
Sensitivity and Specificity
Stroke, Lacunar / diagnostic imaging*
Tomography, X-Ray Computed / methods*