CT Perfusion in Lacunar Stroke: A Systematic Review

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Perfusion imaging in acute ischemic stroke identifies hypoperfused brain regions downstream of arterial occlusion.
• Computed Tomography Perfusion (CTP) is widely used for selecting patients for endovascular treatment.
• Data on CTP performance in lacunar stroke is limited, as these infarcts are theoretically outside CTP's primary purpose.

Purpose of the Study:

• To systematically review the performance of Computed Tomography Perfusion (CTP) in diagnosing lacunar stroke.
• To evaluate CTP's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in acute lacunar stroke patients.

Main Methods:

• A systematic review of PubMed and EMBASE databases was conducted.
• Searched for studies combining CTP and lacunar stroke, selecting 14 relevant papers.
• Data extraction focused on CTP technical aspects and diagnostic accuracy metrics.

Main Results:

• A cohort of 583 lacunar stroke patients was analyzed, with mean ages between 59.8-72 years and 32-53.1% female participants.
• CTP was performed using various technologies (16-320 rows), software, and maps.
• Reported sensitivity ranged from 0% to 62.5%, and specificity from 20% to 100%.

Conclusions:

• CTP cannot reliably exclude lacunar infarcts when no perfusion deficit is detected.
• The underlying pathophysiology of lacunar infarcts is more intricate than previously understood.