Predictive Value of CT Brain Perfusion Studies in Acute Ischemic Infarct Taking MRI Stroke Protocol As Gold Standard

Background Acute ischemic stroke is the leading cause of serious chronic disability worldwide. Imaging plays a key role in early diagnosis and intervention, thus reducing mortality and morbidity related to ischemic stroke. Computed tomography (CT) perfusion study is a valuable imaging tool for the assessment of acute infarction. The objective of this study was to determine the predictive value of CT perfusion in diagnosing acute ischemic infarction taking Magnetic Resonance Imaging (MRI) stroke protocol (including Diffusion Weighted Imaging (DWI)) as a gold standard. Methods The cross-sectional validation study was conducted at a teaching hospital in Islamabad from June 2019 to December 2019. The study comprised a total of 125 patients of either gender with suspected acute ischemic stroke. The patients were scanned for CT perfusion and MRI stroke protocol on the same day. Scans were reported separately for the detection of acute ischemic infarction by the same consultant radiologist. The predictive value of CT perfusion was calculated accordingly. Results Of the 125 patients, 58% were male and 42% were female. The age of selected patients ranged between 38 to 70 years with a mean age of 56.12 ± 9.69 years. Acute ischemic infarction was detected in 86 (69%) patients by CT perfusion study and in 120 (96%) patients by MRI stroke protocol. The positive predicted value of CT perfusion for the detection of acute infarction was calculated as 98.83 and the negative predicted value was 10.25. Conclusion CT perfusion study provides adequate sensitivity and specificity with good predictive value in the detection of acute ischemic infarct in stroke patients. This widely available and time-effective modality aids in the triage of patients for immediate endovascular intervention leading to maximal neurological benefit and improving outcomes.