University Clinic of Radiology, University Hospital Münster, University of Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
Sci Rep. 2024 Oct 23;14(1):25093. doi: 10.1038/s41598-024-76531-6.
To evaluate whether incorporating CT perfusion imaging can significantly enhance diagnostic CT accuracy in stroke detection. Two 3rd-year residents (3rd of 5 years of residency) reviewed CT scans of 200 patients with suspected stroke, consisting of 104 patients with a proven stroke and a control group with 96 patients. They analyzed each patient in a blinded and randomized manner in two runs. In one session, they had only non-contrast CT and CT angiography available for diagnosis; in the other session at a later time point, an additional CT perfusion imaging was available. The performance achieved by the two readers was determined in terms of AUC (area under the curve), accuracy, sensitivity, specificity, positive and negative predictive value and Cohen's Kappa. Reader 1 achieved an AUC of 87.64% with the basic stroke-protocol vs. an AUC of 97.4% with an additional CT-perfusion given. Based on the DeLong test, these values differ significantly (p-value: 0.00017). Reader 2 achieved an AUC of 91.23% in basic stroke-protocol vs. an AUC of 96.42% with an additional CT-perfusion. These values also differ significantly (p-value: 0.02612).. The performance gain achieved with CT-perfusion is most evident in the decrease in the number of false classified cases (Reader 1: 24 to 5; Reader 2: 18 or 14 to 7) and the significant increase in Cohen's kappa. Our study shows that additional CT-perfusion imaging in stroke diagnosis significantly improves the diagnostic reliability of residents. Therefore, it should be further investigated whether perfusion imaging should be a general standard of initial stroke diagnosis no matter of the onset.
为了评估在脑卒中检测中纳入 CT 灌注成像是否能显著提高诊断 CT 的准确性。两名三年级住院医师（五年住院医师中的第三年）回顾了 200 名疑似脑卒中患者的 CT 扫描，其中包括 104 名确诊脑卒中患者和对照组 96 名患者。他们以盲法和随机方式对每位患者进行两次分析。在一次检查中，他们仅使用非对比 CT 和 CT 血管造影进行诊断；在另一次检查中，在稍后的时间点，还可使用 CT 灌注成像。两名读者的表现通过 AUC（曲线下面积）、准确性、敏感性、特异性、阳性和阴性预测值以及 Cohen's Kappa 来确定。读者 1 使用基本脑卒中方案的 AUC 为 87.64%，而使用额外的 CT 灌注的 AUC 为 97.4%。根据 DeLong 检验，这些值差异显著（p 值：0.00017）。读者 2 在基本脑卒中方案中的 AUC 为 91.23%，而在额外的 CT 灌注中的 AUC 为 96.42%。这些值也有显著差异（p 值：0.02612）。使用 CT 灌注获得的性能增益在假分类病例数的减少（读者 1：24 例降至 5 例；读者 2：18 例或 14 例降至 7 例）和 Cohen's kappa 的显著增加中最为明显。我们的研究表明，脑卒中诊断中额外的 CT 灌注成像显著提高了住院医师的诊断可靠性。因此，应进一步研究灌注成像是否应成为初始脑卒中诊断的一般标准，无论发病时间如何。
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