Bollwein Christine, Plate Annika, Sommer Wieland H, Thierfelder Kolja M, Janssen Hendrik, Reiser Maximilian F, Straube Andreas, von Baumgarten Louisa
Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital of Munich, Munich, Germany.
Department of Neurology, Ludwig-Maximilians-University Hospital of Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany.
Neuroradiology. 2016 Nov;58(11):1077-1085. doi: 10.1007/s00234-016-1743-5. Epub 2016 Sep 20.
Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate.
Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes. Two blinded readers evaluated NECT and four different CTP maps independently for the presence and location of infratentorial ischemic perfusion deficits.
The study was designed as a retrospective case-control study and included 280 patients (cases/controls = 1/3). WB-CTP revealed a greater diagnostic sensitivity than NECT (41.4 vs. 17.1 %, P = 0.003). The specificity, however, was comparable (93.3 vs. 95.0 %). Mean transit time (MTT) and time to drain (TTD) were the most sensitive (41.4 and 40.0 %) and cerebral blood volume (CBV) the most specific (99.5 %) perfusion maps. Infarctions detected using WB-CTP were significantly larger than those not detected (15.0 vs. 2.2 ml; P = 0.0007); infarct location, however, did not influence the detection rate.
The detection of infratentorial infarctions can be improved by assessing WB-CTP as part of the multimodal stroke workup. However, it remains a diagnostic challenge, especially small volume infarctions in the brainstem are likely to be missed.
尽管全脑计算机断层扫描灌注成像（WB-CTP）在检测幕上梗死方面的诊断性能已得到充分证实，但其在检测幕下卒中方面的价值仍不太明确。我们研究了其在检测幕下梗死方面的诊断准确性，并将其与非增强计算机断层扫描（NECT）进行比较，旨在确定影响其检测率的因素。
在1380例因疑似卒中接受WB-CTP检查的患者队列中，我们回顾性纳入了所有经MRI证实为幕下卒中的患者，并将其与无幕下卒中的对照患者进行比较。两名盲法阅片者独立评估NECT和四张不同的CTP图谱，以确定幕下缺血灌注缺损的存在和位置。
该研究设计为回顾性病例对照研究，纳入280例患者（病例/对照 = 1/3）。WB-CTP显示出比NECT更高的诊断敏感性（41.4%对17.1%，P = 0.003）。然而，特异性相当（93.3%对95.0%）。平均通过时间（MTT）和引流时间（TTD）是最敏感的灌注图谱（分别为41.4%和40.0%），而脑血容量（CBV）是最特异的灌注图谱（99.5%）。使用WB-CTP检测到的梗死灶明显大于未检测到的梗死灶（15.0对2.2 ml；P = 0.0007）；然而，梗死灶位置并不影响检测率。
将WB-CTP作为多模式卒中检查的一部分进行评估，可提高幕下梗死的检测率。然而，这仍然是一个诊断挑战，尤其是脑干的小体积梗死可能会被漏诊。
