Erik J R J van der Hoeven1, Jan Willem Dankbaar2, Ale Algra2, Jan Albert Vos2, Joris M Niesten2, Tom van Seeters2, Irene C van der Schaaf2, Wouter J Schonewille2, L Jaap Kappelle2, Birgitta K Velthuis2. 1. From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands. e.van.der.hoeven@antoniusziekenhuis.nl. 2. From the Departments of Radiology (E.J.R.J.v.d.H., J.A.V.) and Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein, the Netherlands; and Department of Radiology, Brain Center Rudolf Magnus (J.W.D., J.M.N., T.v.S., I.C.v.d.S., B.K.V.), Department Neurology and Neurosurgery (L.J.K., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.
Abstract
BACKGROUND AND PURPOSE: Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. METHODS: Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. RESULTS: Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; P(C versus A)<0.001) and B (area under the curve from the receiver operating characteristic curve=0.68; 95% confidence interval, 0.56-0.79; P(C versus B)<0.001). CONCLUSIONS: CT perfusion has significant additional diagnostic values to noncontrast CT and CT angiography source images for detecting ischemic changes in patients suspected of acute posterior circulation stroke.
BACKGROUND AND PURPOSE: Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. METHODS:Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. RESULTS: Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve from the receiver operating characteristic curve=0.86; 95% confidence interval, 0.77-0.94) predicted an infarct in the posterior circulation territory better than models A (area under the curve from the receiver operating characteristic curve=0.64; 95% confidence interval, 0.53-0.76; P(C versus A)<0.001) and B (area under the curve from the receiver operating characteristic curve=0.68; 95% confidence interval, 0.56-0.79; P(C versus B)<0.001). CONCLUSIONS: CT perfusion has significant additional diagnostic values to noncontrast CT and CT angiography source images for detecting ischemic changes in patients suspected of acute posterior circulation stroke.
Authors: Christine Bollwein; Annika Plate; Wieland H Sommer; Kolja M Thierfelder; Hendrik Janssen; Maximilian F Reiser; Andreas Straube; Louisa von Baumgarten Journal: Neuroradiology Date: 2016-09-20 Impact factor: 2.804
Authors: Matthias P Fabritius; Paul Reidler; Matthias F Froelich; Lukas T Rotkopf; Thomas Liebig; Lars Kellert; Katharina Feil; Steffen Tiedt; Philipp M Kazmierczak; Kolja M Thierfelder; Daniel Puhr-Westerheide; Wolfgang G Kunz Journal: J Am Heart Assoc Date: 2019-10-19 Impact factor: 5.501
Authors: Frans Kauw; Fasco van Ommen; Edwin Bennink; Maarten J Cramer; L Jaap Kappelle; Richard Ap Takx; Birgitta K Velthuis; Max A Viergever; H Wouter van Es; Wouter J Schonewille; Jonathan M Coutinho; Charles Blm Majoie; Henk A Marquering; Hugo Wam de Jong; Jan W Dankbaar Journal: Eur Stroke J Date: 2020-10-23