From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Stroke. 2015 Apr;46(4):1113-5. doi: 10.1161/STROKEAHA.115.008718. Epub 2015 Mar 5.
Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke.
Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics.
Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; P(C versus A)<0.001) and B (area under the curve from the receiver operating characteristic curve=0.68; 95% confidence interval, 0.56-0.79; P(C versus B)<0.001).
CT perfusion has significant additional diagnostic values to noncontrast CT and CT angiography source images for detecting ischemic changes in patients suspected of acute posterior circulation stroke.
对后循环急性梗死的检测具有挑战性。我们旨在确定 CT 灌注对非对比 CT 和 CT 血管造影原始图像在疑似急性缺血性后循环卒中患者中的梗死检测和定位的附加价值。
从荷兰急性卒中试验（DUST）研究中选择疑似急性缺血性后循环卒中的患者。患者在卒中发病后 9 小时内接受非对比 CT、CT 血管造影和 CT 灌注检查，并在随访时接受 CT 或 MRI 检查。对缺血的征象和位置进行图像评估。比较了 3 个分层逻辑回归模型（非对比 CT [A]、添加的 CT 血管造影原始图像 [B]和 CT 灌注 [C]）的区分能力，并通过 C 统计量进行比较。
在 88 例患者中，76 例（86%）出院时临床诊断为缺血性卒中，42 例（48%）在随访影像学上显示后循环梗死。模型 C（受试者工作特征曲线下面积=0.86；95%置信区间，0.77-0.94）比模型 A（受试者工作特征曲线下面积=0.64；95%置信区间，0.53-0.76；P（C 与 A）<0.001）和 B（受试者工作特征曲线下面积=0.68；95%置信区间，0.56-0.79；P（C 与 B）<0.001）更好地预测了后循环区域的梗死。
CT 灌注对疑似急性后循环卒中患者的缺血性改变的检测具有比非对比 CT 和 CT 血管造影原始图像更显著的附加诊断价值。
