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CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke.

Abstract：

INTRODUCTION:We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. METHODS:We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R (2) was assessed to determine the additional value of CTA and CTP. RESULTS:At follow-up, 612 patients (67.5%) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95% confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95% CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95% CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95% CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R (2) = 0.58) was superior to patient characteristics and non-contrast CT alone (R (2) = 0.44) and to addition of CTA alone (R (2) = 0.55) or CTP alone (R (2) = 0.54; all p < 0.001). CONCLUSION:In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment.

journal_name

Neuroradiology

journal_title

Neuroradiology

authors

van Seeters T,Biessels GJ,Kappelle LJ,van der Schaaf IC,Dankbaar JW,Horsch AD,Niesten JM,Luitse MJ,Majoie CB,Vos JA,Schonewille WJ,van Walderveen MA,Wermer MJ,Duijm LE,Keizer K,Bot JC,Visser MC,van der Lugt A,Dippel D

doi

10.1007/s00234-015-1636-z

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

327-37

issue

eissn

0028-3940

issn

1432-1920

pii

10.1007/s00234-015-1636-z

journal_volume

pub_type

杂志文章,多中心研究

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CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke.