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Perfusion Deficits in Different Mechanisms of Two Subtypes of Acute Stroke with Diffusion MRI Confirmation
Cuiting Zhu1, Wei Qin1, Wenli Hu1
1Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Insights
Branch atheromatous disease (BAD) causes more perfusion deficits than lacunar infarction (LI). CT perfusion imaging helps identify these differences in acute stroke subtypes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute stroke comprises various subtypes, including Branch Atheromatous Disease (BAD) and Lacunar Infarction (LI).
- Investigating the distinct mechanisms and clinical characteristics of these stroke subtypes is crucial for effective management.
Purpose of the Study:
- To compare perfusion deficits and clinical features between BAD and LI acute stroke subtypes.
- To evaluate the utility of CT perfusion (CTP) in differentiating these stroke mechanisms.
Main Methods:
- Retrospective review of 599 CTP examinations in acute stroke patients within 12 hours of symptom onset.
- Patients classified into BAD and LI groups based on diffusion MRI; lesion volumes assessed using NCCT, CTA, CBV, CBF, MTT, and TTP maps.
- Region-of-interest analysis and follow-up MRI used for confirmation.
Main Results:
- 133 patients met inclusion criteria; 78.2% in BAD group, 21.8% in LI group.
- Perfusion deficits were more frequent in the BAD group (53.8%) compared to the LI group (27.8%) in the supratentorial region (P < 0.05).
- CTP demonstrated high specificity (up to 100%) for identifying BAD, with TTP showing the highest sensitivity (90.5%).
Conclusions:
- CTP exhibits high specificity in identifying Branch Atheromatous Disease (BAD).
- Compromised perfusion deficits are significantly more prevalent in BAD patients than in LI patients.
- CT perfusion imaging is valuable for assessing the clinical significance of perfusion abnormalities in BAD.
Background:
Branch atheromatous disease (BAD) and lacunar infract (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke.
Materials And Methods:
Five hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Based on diffusion MRI, the patients were assigned to one of two subtypes: BAD and LI. Lesion volumes were measured on NCCT, CTA, CBV, CBF, MTT, and TTP maps by region-of-interest analysis and were confirmed by follow-up MRI.
Results:
One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) BAD group and 5 of 18 (27.8%) LI group had perfusion deficits in the supratentorial region. BAD had a higher proportion of abnormal perfusion than LI patients, with a significant difference (P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in BAD patients.
Conclusion:
CTP has high specificity in identifying BAD. Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.
