Investigative Radiology

Skip Navigation LinksHome > April 2014 - Volume 49 - Issue 4 > Diagnostic Accuracy of Whole-Brain Computed Tomographic Perf...
Investigative Radiology:
doi: 10.1097/RLI.0000000000000023
Original Articles

Diagnostic Accuracy of Whole-Brain Computed Tomographic Perfusion Imaging in Small-Volume Infarctions

Thierfelder, Kolja M. MD, MSc*; von Baumgarten, Louisa MD; Löchelt, Antje C.*; Meinel, Felix G. MD*; Armbruster, Marco MD*; Beyer, Sebastian E.*; Patzig, Maximilian MD; Opherk, Christian MD†§; Reiser, Maximilian F. MD*; Sommer, Wieland H. MD, MPH*

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Abstract

Purpose: The aims of this study were to determine the diagnostic accuracy of whole-brain computed tomographic perfusion (WB-CTP) in small ischemic brain infarctions and to identify factors influencing the detection rate.

Materials and Methods: Out of a retrospective cohort of 1380 subjects who underwent initial WB-CTP because of suspected stroke, we selected all patients with a supratentorial magnetic resonance imaging-confirmed ischemic infarction with a volume of 8 mL or less. Infratentorial lesions were excluded. The study was designed as a case-control study with a ratio of cases to controls with no infarction in follow-up magnetic resonance imaging of 1:3. Two blinded readers independently evaluated 4 different computed tomographic perfusion parameter data sets per subject with respect to the presence and localization of a perfusion deficit.

Results: A total of 113 subjects met the inclusion criteria for the patient group. Overall, WB-CTP reached a sensitivity of 43.4% and a specificity of 92.9%. Among these, cortical infarctions were detected in 31 (69%) of 49 cases, whereas subcortical infarctions were detected only in 18 (28%) of 64 cases (P < 0.05). Mean final infarction diameter (17.3 mm) and volume (1.9 mL) of infarctions detected on CTP were significantly larger than those of infarctions not detected (12.4 mm and 0.8 mL, respectively; P < 0.001). Time from symptom onset did not differ significantly between infarctions that were detected or those that were not (204 vs 189 minutes; P = 0.75).

Conclusions: The detection rate of WB-CTP in small infarctions highly depends on infarction localization and final size, whereas time from symptom onset does not seem to influence diagnostic accuracy.

© 2014 by Lippincott Williams & Wilkins

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