Enas A Abdelgawad1, Mahmoud M Higazi2, Abdelraouf O Abdelbaky3, Hosny S Abdelghany1. 1. Department of Radiology, Minia University, Minia, Egypt. 2. Department of Radiology, Minia University, Minia, Egypt. Electronic address: mahmoud.higazi@mu.edu.eg. 3. Department of Neurology, Minia University, Minia, Egypt.
Abstract
BACKGROUND AND PURPOSE: Recent developments in treatment of ischemic stroke increased importance of defining limits of ischemic insult by imaging. Some studies postulated that CTP is a promising technique, which can discriminate between ischemic core and penumbra. In this study, we sought to evaluate diagnostic performance of CTP-CBV colour maps, regarded as a marker of acute infarct; in comparison with DWI. MATERIALS AND METHODS: We retrospectively analyzed 48 patients with CTA proved major ischemic stroke within 12hours of onset, they had DWI and CTP exams within 1hour of each other, regardless of order. DWI sizes were calculated. Sensitivity, specificity, PPV and NPV of CBV colour maps for identification of acute infarcts were calculated. ROC curve was constructed. RESULTS: CBV colour maps missed a lot of small infarcts that were identified by DWI with an overall diagnostic accuracy of (62.5%) and low sensitivity (38.5%) for patients whom DWI size<70mL. Area under curve was 0.79. DWI size was an only predictor of abnormal CBV colour maps (P=0.005). CONCLUSIONS: Assuming direct equivalence of DWI and CBV-based core might be unrealistic for individual patients in clinical practice. CBV colour maps are highly specific for acute infarcts, but with lack of sufficient sensitivity; particularly for small sized infarcts.
BACKGROUND AND PURPOSE: Recent developments in treatment of ischemic stroke increased importance of defining limits of ischemic insult by imaging. Some studies postulated that CTP is a promising technique, which can discriminate between ischemic core and penumbra. In this study, we sought to evaluate diagnostic performance of CTP-CBV colour maps, regarded as a marker of acute infarct; in comparison with DWI. MATERIALS AND METHODS: We retrospectively analyzed 48 patients with CTA proved major ischemic stroke within 12hours of onset, they had DWI and CTP exams within 1hour of each other, regardless of order. DWI sizes were calculated. Sensitivity, specificity, PPV and NPV of CBV colour maps for identification of acute infarcts were calculated. ROC curve was constructed. RESULTS: CBV colour maps missed a lot of small infarcts that were identified by DWI with an overall diagnostic accuracy of (62.5%) and low sensitivity (38.5%) for patients whom DWI size<70mL. Area under curve was 0.79. DWI size was an only predictor of abnormal CBV colour maps (P=0.005). CONCLUSIONS: Assuming direct equivalence of DWI and CBV-based core might be unrealistic for individual patients in clinical practice. CBV colour maps are highly specific for acute infarcts, but with lack of sufficient sensitivity; particularly for small sized infarcts.
Authors: Rebecca Kassubek; Lars Bullinger; Jan Kassubek; Jens Dreyhaupt; Albert C Ludolph; Katharina Althaus; Jan Lewerenz Journal: J Neurol Date: 2017-02-28 Impact factor: 4.849