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Computed tomography perfusion in stroke mimics.

James E Siegler1, Jon Rosenberg1, Daniel Cristancho1

  • 1Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

International Journal of Stroke : Official Journal of the International Stroke Society
|August 15, 2019
PubMed
Summary
This summary is machine-generated.

Automated computed tomography perfusion (CTP) can identify stroke mimics. While some stroke mimic patients show CTP abnormalities, these patterns are often discordant with clinical symptoms, aiding diagnosis.

Keywords:
Cerebral infarctioncomputed tomography scanlarge vessel occlusionperfusion imagingradiologystroke mimic

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Stroke mimics present a diagnostic challenge, often mimicking acute ischemic stroke symptoms.
  • Computed tomography perfusion (CTP) is increasingly used to assess brain perfusion in suspected stroke.
  • Automated analysis of CTP data may improve diagnostic accuracy for stroke mimics.

Purpose of the Study:

  • To determine the prevalence and patterns of abnormal findings on automated CTP in patients with stroke mimic.
  • To compare CTP findings between patients with stroke/transient ischemic attack and stroke mimic.
  • To evaluate the utility of CTP in differentiating stroke mimics from actual ischemic events.

Main Methods:

  • Retrospective review of a multi-site cohort of patients undergoing CTP for suspected acute ischemic stroke.
  • Comparison of hypoperfusion abnormalities on automated CTP (iSchemaView RAPID) between stroke/transient ischemic attack and stroke mimic groups.
  • Analysis focused on absence of perfusion abnormalities and discordance with clinical symptoms and CT angiography findings.

Main Results:

  • Of 348 patients meeting inclusion criteria, 151 (43%) were stroke mimics.
  • Abnormal time-to-maximum (Tmax > 6s) perfusion was less common in stroke mimics (28%) compared to stroke/TIA patients (62%).
  • Abnormal Tmax patterns were more frequently discordant with clinical symptoms in stroke mimics (71%) than in stroke/TIA patients (9%), with a high negative predictive value (91%) for identifying mimics.

Conclusions:

  • A significant proportion of stroke mimics exhibit Tmax abnormalities on automated CTP.
  • However, these abnormalities are often discordant with clinical presentation and vessel status.
  • Normal or discordant Tmax patterns on automated CTP are more common in stroke mimics and can aid in clinical decision-making for stroke treatment.