Focal Hypoperfusion in Acute Ischemic Stroke Perfusion CT: Clinical and Radiologic Predictors and Accuracy for Infarct Prediction.

Details

Serval ID
serval:BIB_0A2C4FB35B8C
Type
Article: article from journal or magazin.
Collection
Publications
Title
Focal Hypoperfusion in Acute Ischemic Stroke Perfusion CT: Clinical and Radiologic Predictors and Accuracy for Infarct Prediction.
Journal
AJNR. American journal of neuroradiology
Author(s)
Bill O., Inácio N.M., Lambrou D., Wintermark M., Ntaios G., Dunet V., Michel P.
ISSN
1936-959X (Electronic)
ISSN-L
0195-6108
Publication state
Published
Issued date
03/2019
Peer-reviewed
Oui
Volume
40
Number
3
Pages
483-489
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Perfusion CT may improve the diagnostic performance of noncontrast CT in acute ischemic stroke. We assessed predictors of focal hypoperfusion in acute ischemic stroke and perfusion CT performance in predicting infarction on follow-up imaging.
Patients from the Acute STroke Registry and Analysis of Lausanne data base with acute ischemic stroke and perfusion CT were included. Clinical and radiologic data were collected. We identified predictors of focal hypoperfusion using multivariate analyses.
From the 2216 patients with perfusion CT, 38.2% had an acute ischemic lesion on NCCT and 73.3% had focal hypoperfusion on perfusion CT. After we analyzed 104 covariates, high-admission NIHSS, visual field defect, aphasia, hemineglect, sensory deficits, and impaired consciousness were positively associated with focal hypoperfusion. Negative associations were pure posterior circulation, lacunar strokes, and anticoagulation. After integrating radiologic variables into the multivariate analyses, we found that visual field defect, sensory deficits, hemineglect, early ischemic changes on NCCT, anterior circulation, cardioembolic etiology, and arterial occlusion were positively associated with focal hypoperfusion, whereas increasing onset-to-CT delay, chronic vascular lesions, and lacunar etiology showed negative association. Sensitivity, specificity, and positive and negative predictive values of focal hypoperfusion on perfusion CT for infarct detection on follow-up MR imaging were 66.5%, 79.4%, 96.2%, and 22.8%, respectively, with an overall accuracy of 76.8%.
Compared with NCCT, perfusion CT doubles the sensitivity in detecting acute ischemic stroke. Focal hypoperfusion is independently predicted by stroke severity, cortical clinical deficits, nonlacunar supratentorial strokes, and shorter onset-to-imaging delays. A high proportion of patients with focal hypoperfusion developed infarction on subsequent imaging, as did some patients without focal hypoperfusion, indicating the complementarity of perfusion CT and MR imaging in acute ischemic stroke.
Keywords
Aged, Aged, 80 and over, Brain Ischemia/diagnostic imaging, Female, Humans, Image Interpretation, Computer-Assisted/methods, Male, Middle Aged, Neuroimaging/methods, Perfusion Imaging/methods, Sensitivity and Specificity, Stroke/diagnostic imaging, Tomography, X-Ray Computed/methods
Pubmed
Web of science
Create date
01/04/2019 17:13
Last modification date
06/03/2020 7:20
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