Lambert Julie, Coursier Kristof, Michiels Laura, Maes Louise, Vandewalle Lieselotte, Demaerel Victor, Wouters Anke, Demaerel Philippe, Lemmens Robin, Demeestere Jelle
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Department of Neurosciences, Experimental Neurology, Laboratory of Neurobiology Leuven, KU Leuven- University of Leuven, Leuven, Belgium.
Neuroradiology. 2025 Apr 24. doi: 10.1007/s00234-025-03618-w.
Detection of intracranial arterial occlusions on CT angiography (CTA) can be challenging. We studied the value of CT perfusion (CTP) for arterial occlusion detection in the anterior circulation amongst radiologists and neurologists, both experienced and less experienced.
Seven raters reviewed CTAs of 335 acute stroke patients with and without occlusions. We evaluated occlusion detection with and without CTP. We categorized the occlusions by location. Two experienced raters exposed to all baseline and follow-up imaging defined a consensus gold standard. We calculated sensitivity, specificity and accuracy for occlusion detection with and without CTP and compared the area under the curve (AUC). We also compared the performance of radiologists versus neurologists and of experienced and less experienced raters.
We included 260 patients with ≥1 occlusion and 75 without occlusions. The accuracy of occlusion detection was greater with CTP assistance compared to CTA only (AUC 0.93 vs 0.91, p= 0.03 for proximal and AUC 0.88 vs 0.81, p<0.001 for distal). Distal occlusion detection accuracy improved with CTP in neurologists and in radiologists, whereas improved proximal occlusion detection accuracy was only present in neurologists. Adding CTP improved distal occlusion detection in experienced and less experienced raters. Proximal occlusion detection accuracy improved with CTP in experienced raters, and trended towards improvement in less experienced raters.
Assistance of CTP maps may improve the accuracy of intracranial occlusion detection on CTA. In this study, the benefit was most profound for distal occlusions, regardless of experience level or specialty background of the rater.
在CT血管造影（CTA）上检测颅内动脉闭塞可能具有挑战性。我们研究了CT灌注（CTP）在前循环动脉闭塞检测中对于放射科医生和神经科医生的价值，包括经验丰富和经验较少的医生。
7名评估者对335例急性卒中患者的CTA进行了评估，这些患者有或没有动脉闭塞。我们评估了有无CTP时的闭塞检测情况。我们按位置对闭塞进行了分类。两名接触过所有基线和随访影像的经验丰富的评估者确定了一个共识金标准。我们计算了有无CTP时闭塞检测的敏感性、特异性和准确性，并比较了曲线下面积（AUC）。我们还比较了放射科医生与神经科医生以及经验丰富和经验较少的评估者的表现。
我们纳入了260例有≥1处闭塞的患者和75例无闭塞的患者。与仅使用CTA相比，CTP辅助下的闭塞检测准确性更高（近端AUC为0.93对0.91，p = 0.03；远端AUC为0.88对0.81，p<0.001）。神经科医生和放射科医生在使用CTP时远端闭塞检测准确性均有所提高，而近端闭塞检测准确性仅在神经科医生中有所提高。添加CTP可提高经验丰富和经验较少的评估者对远端闭塞的检测能力。经验丰富的评估者在使用CTP时近端闭塞检测准确性提高，经验较少的评估者也有提高的趋势。
CTP图的辅助可能会提高CTA上颅内闭塞检测的准确性。在本研究中，无论评估者的经验水平或专业背景如何，对远端闭塞的益处最为显著。
