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Published on: February 17, 2013
Diagnostic Value of Perfusion Parameters for Differentiation of Underlying Etiology in Internal Carotid Artery
Daniel Weiss1, Henrik Lang2, Christian Rubbert3
1Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. danielarvid.weiss@med.uni-duesseldorf.de.
Insights
Computed tomography perfusion (CT-P) can differentiate embolic from macroangiopathic internal carotid artery (ICA) occlusions using mean transit time (MTT) ratios. However, CT-P parameters could not distinguish dissection-related ICA occlusions from other causes in this study.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Internal carotid artery (ICA) occlusions stem from diverse etiologies like dissection, embolism, or macroangiopathy, influencing treatment decisions.
- Distinguishing these causes using computed tomography angiography (CTA) presents diagnostic challenges.
Purpose of the Study:
- To evaluate the utility of computed tomography perfusion (CT-P) parameters in differentiating the etiologies of acute ischemic stroke due to ICA occlusion.
- To determine if CT-P can distinguish between dissection, embolic, and macroangiopathic causes of ICA occlusion.
Main Methods:
- Retrospective analysis of 69 patients with acute ischemic stroke and ICA occlusion who underwent CT-P.
- Comparison of CT-P parameters (rCBV, rCBF, Tmax, MTT) between hemispheres across etiologies using ANOVA and Bonferroni post hoc tests.
- Receiver operating characteristic (ROC) analysis and multinomial logistic regression (MLR) to assess diagnostic performance.
Main Results:
- Mean transit time (MTT) ratio showed significant differences between etiologies (p=0.003).
- MTT ratio effectively differentiated embolic from macroangiopathic ICA occlusions (AUC=0.77, cut-off=1.15).
- CT-P parameters did not differentiate dissection from embolic or macroangiopathic etiologies.
Conclusions:
- Mean transit time (MTT) ratio derived from CT-P can distinguish between embolic and macroangiopathic internal carotid artery occlusions.
- CT-P parameters, in this cohort, were insufficient for differentiating dissection-related ICA occlusions from other causes.
Purpose:
Occlusions of the internal carotid artery (ICA) may be caused by dissection, embolic or macroangiopathic pathogenesis, which partially influences the treatment; however, inferring the underlying etiology in computed tomography angiography can be challenging. In this study, we investigated whether computed tomography perfusion (CT-P) parameters could be used to distinguish between etiologies.
Methods:
Patients who received CT‑P in acute ischemic stroke due to ICA occlusion between 2012 and 2019 were retrospectively analyzed. Group comparisons between etiologies regarding the ratios of CT‑P parameters between both hemispheres for relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), time to maximum (Tmax), and mean transit time (MTT) were calculated by one-factorial analysis of variance (ANOVA) and compared by pairwise Bonferroni post hoc tests. An receiver operating characteristics (ROC) analysis was performed if differences in group comparisons were found. Multinomial logistic regression (MLR) including pretherapeutic parameters was calculated for etiologies.
Results:
In this study 69 patients (age = 70 ± 14 years, dissection = 10, 14.5%, embolic = 19, 27.5% and macroangiopathic = 40, 58.0%) were included. Group differences in ANOVA were only found for MTT ratio (p = 0.003, η2 = 0.164). In the post hoc test, MTT ratio showed a differentiability between embolic and macroangiopathic occlusions (p = 0.002). ROC analysis for differentiating embolic and macroangiopathic ICA occlusions based on MTT ratio showed an AUC of 0.77 (p < 0.001, CI = 0.65-0.89) and a cut-off was yielded at a value of 1.15 for the MTT ratio (sensitivity 73%, specificity 68%). The MLR showed an overall good model performance.
Conclusion:
It was possible to differentiate between patients with embolic and macroangiopathic ICA occlusions based on MTT ratios and to define a corresponding cut-off. Differentiation from patients with dissection versus the other etiologies was not possible by CT‑P parameters in our sample.
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