Multimodal CT provides improved performance for lacunar infarct detection.

Area of Science:

• Neuroradiology
• Cerebrovascular Diseases
• Medical Imaging

Background:

• Lacunar infarcts constitute about 25% of acute ischemic strokes.
• CT Perfusion (CTP) enhances infarct detection sensitivity compared to non-contrast CT (NCCT) alone.
• The diagnostic utility and reliability of incremental CT protocols for lacunar infarction require systematic evaluation.

Purpose of the Study:

• To systematically assess the diagnostic benefit of an incremental CT protocol in identifying lacunar infarction.
• To evaluate the interobserver reliability of using NCCT, CT angiography (CTA), and CTP incrementally.

Main Methods:

• 163 patients with lacunar syndrome within 4.5 hours of symptom onset were enrolled.
• Images were incrementally reviewed by two blinded readers (NCCT only, NCCT/CTA, NCCT/CTA/CTP).
• Diagnostic confidence was assessed, and logistic regression analyzed diagnostic accuracy and predictive effects.

Main Results:

• Sensitivity for lacunar infarct detection significantly increased from 9.3% to 42.4% with the incremental protocol.
• CTP demonstrated a higher area under the curve (0.77) compared to CTA (0.68) and NCCT (0.55).
• The observed diagnosis using CTP was significantly more likely to confirm lacunar infarct than NCCT or CTA.

Conclusions:

• CT Perfusion (CTP) provides a superior diagnostic benefit for identifying lacunar infarction.
• Incremental CT protocols, particularly those including CTP, enhance diagnostic accuracy for lacunar infarcts.