CT Perfusion in Acute Lacunar Stroke: Detection Capabilities Based on Infarct Location

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Recent studies suggest CT Perfusion (CTP) is superior to NCCT/CTA for detecting lacunar infarcts.
• Lacunar infarcts are small ischemic strokes often challenging to visualize.

Purpose of the Study:

• To evaluate the capability of CT Perfusion (CTP) in identifying lacunar infarcts across different intracranial regions.
• To compare CTP performance against Diffusion-Weighted Imaging (DWI) for lacunar infarct detection.

Main Methods:

• Retrospective review of 1085 CTP examinations in acute stroke patients within 12 hours of symptom onset.
• Infarct detection and characterization using CTP (CBF, CBV, MTT, TTP) and DWI, with exclusion of larger infarcts.
• Three blinded reviewers assessed infarcts based on NIHSS scores, symptoms, and imaging findings.

Main Results:

• Out of 113 patients, 32.7% had lacunar infarcts on DWI.
• CTP showed low sensitivity (18.9%-48.7%) but high specificity (97.4%-98.7%) for lacunar infarcts.
• Sensitivity was highest in subcortical white matter (21.7%-65.2%) but 0% in the thalami and basal ganglia.

Conclusions:

• CTP demonstrates low sensitivity and high specificity for identifying lacunar infarcts.
• CTP's sensitivity is limited in the basal ganglia and thalami, despite good performance in subcortical white matter.