Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.G.-E., F.M., N.J.S.).
Hunter Medical Research Institute and University of Newcastle, Australia (C.G.-E., F.M., T.L., C.R.L., N.J.S., M.W.P.).
Stroke. 2021 Jan;52(1):339-343. doi: 10.1161/STROKEAHA.120.030455. Epub 2020 Dec 2.
Lacunar syndromes correlate with a lacunar stroke on imaging in 50% to 60% of cases. Computed tomography perfusion (CTP) is becoming the preferred imaging modality for acute stroke triage. We aimed to estimate the sensitivity, specificity, and predictive values for noncontrast computed tomography and CTP in lacunar syndromes, and for cortical, subcortical, and posterior fossa regions.
A retrospective analysis of confirmed ischemic stroke patients who underwent acute CTP and follow-up magnetic resonance imaging between 2010 and 2018 was performed. Brain noncontrast computed tomography and CTP were assessed independently by 2 stroke neurologists. Receiver operating characteristic curve analysis was performed to estimate sensitivity, specificity, and area under the curve (AUC) for the detection of strokes in patients with lacunar syndromes using different CTP maps.
We found 106 clinical lacunar syndromes, but on diffusion-weighted imaging, these consisted of 59 lacunar, 33 cortical, and 14 posterior fossa strokes. The discrimination of ischemia identification was very poor using noncontrast computed tomography in all 3 regions, but good for cortical (AUC, 0.82) and poor for subcortical and posterior regions (AUCs, 0.55 and 0.66) using automated core-penumbra maps. The addition of delay time and mean transient time maps substantially increased subcortical (AUC, 0.80) and slightly posterior stroke detection (AUC, 0.69).
Analysis of mean transient time and delay time maps in combination with core-penumbra maps improves detection of subcortical and posterior strokes.
腔隙综合征在影像学上与腔隙性卒中相关，占 50%至 60%。计算机断层灌注成像（CTP）已成为急性卒中分诊的首选影像学方法。我们旨在评估非对比 CT 和 CTP 在腔隙综合征以及皮质、皮质下和后颅窝区域的敏感性、特异性和预测值。
对 2010 年至 2018 年间接受急性 CTP 和随访磁共振成像的确诊缺血性卒中患者进行了回顾性分析。由 2 位卒中神经病学家独立评估脑非对比 CT 和 CTP。使用不同的 CTP 图进行受试者工作特征曲线分析，以评估在有腔隙综合征的患者中检测卒中的敏感性、特异性和曲线下面积（AUC）。
我们发现 106 例临床腔隙综合征，但在弥散加权成像上，这些综合征包括 59 例腔隙性、33 例皮质性和 14 例后颅窝卒中。在所有 3 个区域，非对比 CT 对缺血的识别都很差，但在皮质区域很好（AUC，0.82），而在皮质下和后颅窝区域较差（AUC 分别为 0.55 和 0.66）。使用自动核心-半影图，添加延迟时间和平均瞬变时间图大大提高了皮质下（AUC，0.80）和轻微的后颅窝卒中检测（AUC，0.69）。
分析平均瞬变时间和延迟时间图结合核心-半影图可以提高皮质下和后颅窝卒中的检测。
