Diagnostic and prognostic utility of computed tomography perfusion imaging in posterior circulation acute ischemic stroke: A systematic review and meta-analysis

Anubhav Katyal; Zeljka Calic; Murray Killingsworth; Sonu Menachem Maimonides Bhaskar

doi:10.1111/ene.14934

Diagnostic and prognostic utility of computed tomography perfusion imaging in posterior circulation acute ischemic stroke: A systematic review and meta-analysis

Eur J Neurol. 2021 Aug;28(8):2657-2668. doi: 10.1111/ene.14934. Epub 2021 Jun 12.

Authors

Anubhav Katyal^{1

2}, Zeljka Calic^{1

2

3

4}, Murray Killingsworth^{1

2

5

6}, Sonu Menachem Maimonides Bhaskar^{1

3

4

5}

Affiliations

¹ Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
² South Western Sydney Clinical School, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia.
³ Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District, Sydney, NSW, Australia.
⁴ Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
⁵ NSW Brain Clot Bank, NSW Health Pathology and NSW Health Statewide Biobank, Sydney, NSW, Australia.
⁶ Correlative Microscopy Facility, Ingham Institute for Applied Medical Research and Department of Anatomical Pathology, NSW Health Pathology and Liverpool Hospital, Liverpool, NSW, Australia.

PMID: 34021664
DOI: 10.1111/ene.14934

Abstract

Background: Computed tomography perfusion (CTP) imaging could be useful in the diagnosis of posterior circulation stroke (PCS) and in identifying patients who are likely to experience favorable outcomes following reperfusion therapy. The current study sought to investigate the diagnostic and prognostic capability of CTP in acute ischemic PCS by performing a systematic review and meta-analysis.

Methods: Medline/PubMed and the Cochrane Library were searched using the terms: "posterior circulation", "CT perfusion", "acute stroke", and "reperfusion therapy". The following studies were included: (1) patients aged 18 years or above; (2) patients diagnosed with PCS; and (3) studies with good methodological design. Pooled sensitivity (SENS), specificity (SPEC), and area under the curve (AUC), computed using the summary receiver operating characteristic (SROC) curves, were used to determine diagnostic/prognostic capability.

Results: Out of 14 studies included, a meta-analysis investigating diagnostic accuracy of CTP was performed on nine studies. Meta-analysis demonstrated comparable diagnostic accuracy of CTP to non-contrast computed tomography (NCCT) (AUC_CTP : 0.90 [95% CI 0.87-0.92] vs. AUC_NCCT : 0.96 [95% CI 0.94-0.97]); however, with higher pooled sensitivity (SENS_CTP : 72% [95% CI 57%-83%] vs. SENS_NCCT : 25% [95% CI 17%-35%]) and lower specificity (SPEC_CTP : 90% [95% CI 83%-94%] vs. SPEC_NCCT : 96% [95% CI 95%-98%]) than NCCT. Meta-analysis to determine prognostic capability of CTP could not be performed.

Conclusions: CTP has limited diagnostic utility in acute ischemic PCS, albeit with superior diagnostic sensitivity and inferior diagnostic specificity to NCCT. Further prospective trials are required to validate the prognostic capability of CTP-derived parameters in PCS.

Keywords: CT perfusion; diagnosis; ischemic stroke; posterior circulation; prognosis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Brain Ischemia* / diagnostic imaging
Cerebrovascular Circulation
Humans
Ischemic Stroke*
Perfusion Imaging
Prognosis
Stroke* / diagnostic imaging
Tomography, X-Ray Computed