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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*

doi: 10.1097/RLI.0000000000000023
Original Articles

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.

From the *Institute of Clinical Radiology, Departments of †Neurology, and ‡Neuroradiology, and §Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.

Received for publication August 31, 2013; and accepted for publication, after revision, October 27, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Kolja M. Thierfelder, MD, MSc, Department of Clinical Radiology, University of Munich Hospitals, Grosshadern Campus, Marchioninistr. 15, 81377 Munich, Germany.

© 2014 by Lippincott Williams & Wilkins