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A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic

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Abstract

Background

Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke.

Methods

We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant.

Results

Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold.

Conclusions

Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke.

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Abbreviations

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

CT:

Computed tomography

CTP:

Computed tomography perfusion

CTA:

Computed tomography angiography

DWI:

Diffusion-weighted imaging

ED:

Emergency Department

MA:

Migrainous aura

MTT:

Mean transit time

MRI:

Magnetic resonance imaging

NECT:

Non-enhanced CT

NIHSS:

National Institutes of Health Stroke Scale

ROI:

Region of interest

SM:

Stroke mimic

SU:

Stroke unit

TTP:

Time to peak

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Acknowledgments

The authors thank Matteo di Franza for the editorial assistance.

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Correspondence to Laura D’Acunto.

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The authors declare that they have no conflict of interest.

Ethical approval

The study has been conducted according to the principles of the Declaration of Helsinki, and it was approved by the Local Ethics Committee CEUR (Comitato Etico Unico Regionale, FVG, Italy) with approval number 115/2018. Each patient provided a written and signed informed consent that allowed the analysis of his/her data for clinical and research purposes.

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Granato, A., D’Acunto, L., Ajčević, M. et al. A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic. Neurol Sci 41, 3321–3328 (2020). https://doi.org/10.1007/s10072-020-04476-5

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