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CT Perfusion in Acute Stroke Predicts Final Infarct Volume- Inter-observer Study.

Jai Jai Shiva Shankar1, Gavin Langlands2, Steve Doucette3

  • 11Department of Diagnostic Imaging,Dalhousie University.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|January 21, 2016
PubMed
Summary

Cerebral blood volume on computed tomography perfusion imaging best predicts final infarct volume in acute ischemic stroke patients. CTP also shows good inter-observer agreement, unlike the ASPECT score.

Keywords:
Acute Ischemic StrokeCT perfusionCerebral Blood VolumeNeurology- AdultNeurology- ClinicalNeuroradiologyNeuroradiology strokestroke imaging

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Area of Science:

  • Neuroradiology
  • Stroke Imaging
  • Cerebrovascular Diseases

Background:

  • Computed tomography perfusion (CTP) is increasingly utilized for acute ischemic stroke (AIS).
  • Comparing baseline CTP and non-contrast CT (Alberta Stroke Program Early CT score - ASPECTS) for infarct volume prediction is crucial.
  • Assessing the impact of training on image interpretation is also important.

Purpose of the Study:

  • To compare the prognostic utility of baseline non-contrast CT (ASPECTS) and CTP in predicting final infarct volume in AIS.
  • To evaluate inter-observer variation in interpreting ASPECTS and CTP.
  • To assess the influence of reader experience on CTP interpretation.

Main Methods:

  • Retrospective analysis of CT and CTP images in AIS patients.
  • Correlation of lesion volume on CTP parameters with final infarct volume.
  • Inter-observer agreement assessed using Kappa statistics and Intra-class correlation coefficients; Pearson correlation coefficients used.

Main Results:

  • Thirty-eight AIS patients were analyzed.
  • Very good inter-observer agreement was found for CTP parameters, contrasting with fair agreement for ASPECTS.
  • Cerebral blood volume (CBV) defect showed the strongest correlation with final infarct volume, followed by cerebral blood flow (CBF) and time to peak (TTP).

Conclusions:

  • Cerebral blood volume defect is the most effective CTP parameter for predicting final infarct volume in AIS.
  • CTP maps demonstrate high inter-observer agreement in predicting final infarct volume, irrespective of reader experience.