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Diagnostic accuracy of whole-brain CT perfusion in the detection of acute infratentorial infarctions

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate.

Methods

Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes. Two blinded readers evaluated NECT and four different CTP maps independently for the presence and location of infratentorial ischemic perfusion deficits.

Results

The study was designed as a retrospective case-control study and included 280 patients (cases/controls = 1/3). WB-CTP revealed a greater diagnostic sensitivity than NECT (41.4 vs. 17.1 %, P = 0.003). The specificity, however, was comparable (93.3 vs. 95.0 %). Mean transit time (MTT) and time to drain (TTD) were the most sensitive (41.4 and 40.0 %) and cerebral blood volume (CBV) the most specific (99.5 %) perfusion maps. Infarctions detected using WB-CTP were significantly larger than those not detected (15.0 vs. 2.2 ml; P = 0.0007); infarct location, however, did not influence the detection rate.

Conclusion

The detection of infratentorial infarctions can be improved by assessing WB-CTP as part of the multimodal stroke workup. However, it remains a diagnostic challenge, especially small volume infarctions in the brainstem are likely to be missed.

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Abbreviations

WB-CTP:

Whole-brain computed tomgraphic perfusion

MTT:

Mean transit time

TTD:

Time to drain

CBV:

Cerebral blood volume

CBF:

Cerebral blood flow

NECT:

Nonenhanced CT

CTA:

CT angiography

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Author notes

    Authors and Affiliations

    1. Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital of Munich, Munich, Germany

      Christine Bollwein, Wieland H. Sommer, Kolja M. Thierfelder & Maximilian F. Reiser

    2. Department of Neurology, Ludwig-Maximilians-University Hospital of Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany

      Annika Plate, Andreas Straube & Louisa von Baumgarten

    3. Department of Neuroradiology, South Nuremberg Hospital, Nuremberg, Germany

      Hendrik Janssen

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    1. Christine Bollwein
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    2. Annika Plate
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    6. Maximilian F. Reiser
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    Correspondence to Louisa von Baumgarten.

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    We declare that all human studies have been approved by the institutional ethics committee of the Medical Faculty of the Ludwig-Maximilians University Munich and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that the ethics committee waived informed patient consent.

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    We declare that we have no conflict of interest.

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    CB and AP contributed equally to this work.

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    Bollwein, C., Plate, A., Sommer, W.H. et al. Diagnostic accuracy of whole-brain CT perfusion in the detection of acute infratentorial infarctions. Neuroradiology 58, 1077–1085 (2016). https://doi.org/10.1007/s00234-016-1743-5

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