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Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Related Experiment Video

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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
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Diagnosing acute lacunar infarction using CT perfusion.

Wenjie Cao1, Nawaf Yassi2, Gagan Sharma3

  • 1Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|February 23, 2016
PubMed
Summary
This summary is machine-generated.

CT perfusion (CTP) shows promise in detecting acute lacunar infarcts (LACI). Mean transit time (MTT) maps demonstrated the highest sensitivity for identifying LACI, suggesting CTP

Keywords:
Acute strokeCT perfusionLacunar infarctionMTT

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Area of Science:

  • Neuroradiology
  • Cerebrovascular Imaging
  • Stroke Diagnostics

Background:

  • The diagnostic utility of CT perfusion (CTP) for acute lacunar infarcts (LACI) remains uncertain.
  • Lacunar infarcts, often caused by deep perforating artery disease, present diagnostic challenges.
  • Establishing reliable CTP markers for LACI is crucial for timely stroke management.

Purpose of the Study:

  • To evaluate the sensitivity of CTP in detecting acute lacunar infarcts (LACI).
  • To compare the diagnostic performance of different CTP parameters (CBV, CBF, MTT, Tmax) for LACI.
  • To assess the inter-observer agreement for LACI detection using CTP.

Main Methods:

  • Retrospective analysis of 63 stroke patient CTP scans (2009-2013) with MRI diffusion imaging as reference standard.
  • Independent evaluation of CTP maps (CBV, CBF, MTT, Tmax) by two neurologists for perfusion lesions in deep perforating artery territories.
  • Calculation of sensitivity, specificity, and inter-observer agreement (Cohen's κ) for CTP parameters.

Main Results:

  • Thirty-two patients had MRI-confirmed LACI (striatum, thalamus, corona radiata); 31 had normal MRI.
  • Mean transit time (MTT) maps showed the highest sensitivity (56.2%) for LACI detection.
  • MTT sensitivity significantly outperformed Tmax (25%), CBV (9.3%), and CBF (43.7%) (p<0.001).

Conclusions:

  • CT perfusion imaging, particularly MTT maps, can detect a significant proportion of acute lacunar infarcts.
  • MTT is a more sensitive CTP parameter than Tmax, CBV, or CBF for identifying LACI.
  • CTP, with MTT mapping, offers a valuable tool for LACI diagnosis in acute stroke settings.