Zhu-Ren Luo, Presenter: Nothing to Disclose

Xiong-Jie Zhuang, Abstract Co-Author: Nothing to Disclose

Rong-Zhou Zhang, Abstract Co-Author: Nothing to Disclose

Bao-Zhong Shen, Abstract Co-Author: Nothing to Disclose

To determine if use of whole-brain CT perfusion (CTP) with an extended range covering the entire brain could improve diagnostic sensitivity and accuracy relative to non-contrast CT (NCCT) for patients presenting with stroke symptoms.

A total of 30 patients presenting to our emergency department with symptoms of ischemic stroke within 4.5 h of the event were included in the study. All were subject to whole-brain Perfusion CT, which includes NCCT, and were then immediately evaluated by diffusion-weighted MRI or DWI. The NCCT and CTP were evaluated by two physicians for evidence of acute infarct and vascular territory, if present. CTP covered the whole brain (16 cm coverage); low relative cerebral blood volume (CBV) in a region of low cerebral blood flow (CBF) or elevated time to peak (TTP) was the operational definition for ischemia or infarct. A third physician rated the DWI for acute infarct and vascular territory, if present. Sensitivity, specificity, and negative and positive predictive values were calculated. Statistical analysis was performed using an exact McNemar test and generalized by estimating equations from a binary logistic regression model to assess the difference in detection rates between modalities. A two-sided P value < 0.05 was considered significant.

Of the 30 patients evaluated, NCCT revealed two (6.7%) acute infarcts without false positives. CTP revealed 28 (93.3%) acute infarcts with one false positive. Of the two infarcts missed on CTP, one was a small cortical infarct, whereas the other was a lacunar type infarct (< 10 mm in size). CTP was significantly more sensitive (93.3 vs. 6.7%, P < 0.05), accurate (76.0 vs. 52.0%, P < 0.05), and had a better negative predictive value (93.5 vs. 51.7%, P < 0.05) than NCCT.

A 320-slice CT allows completing dynamic visualization of entire brain and enables calculation of whole-organ perfusion maps. Whole-brain CTP improved sensitivity and accuracy relative to NCCT in this cohort of 30 patients with symptoms of hyperacute stroke evaluated within 4.5 hours of the event.

320-slice CT can enable calculation of whole-brain perfusion maps and improve sensitivity and accuracy for diagnosing hyperacute stroke.

Luo, Z, Zhuang, X, Zhang, R, Shen, B, Whole-brain 320-detector Row Dynamic Volume CT Perfusion Performed on Hyperacute Ischemic Stroke Patients within 4.5 hours Improves Diagnostic Sensitivity and Accuracy.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13022098.html