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Diagnostic value of whole-brain computed tomographic perfusion imaging for suspected large artery occlusion stroke patients in emergency department

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Abstract

Purpose

To evaluate the diagnostic value of whole-brain computed tomographic perfusion (WB-CTP) in emergency department for suspected large artery occlusion stroke.

Methods

Suspected large artery occlusion (LAO) stroke patients had initial WB-CTP in the neurological emergency department from August 2016 to August 2018 were retrospectively reviewed for analysis. The sensitivity and specificity of non-contrast computed tomographic scan (NCCT) or WB-CTP for diagnosis of cerebral infarction was compared between the anterior circulation and posterior circulation. The imaging characteristics of WB-CTP in patients with stroke-mimics were described.

Results

Among the 300 included patients, 259 patients (86.3%) were finally diagnosed as cerebral infarction, 16 (5.3%) were transient ischemic attack, 10 (3.3%) were epileptic seizure and 3 (1%) were cerebral venous sinus thrombosis (CVST). For patients with final diagnosis of cerebral infarction, WB-CTP found abnormality in 206 cases (79.5%). NCCT had poor sensitivity (4.6%) but high specificity (100%) for cerebral infarction. The CTP imaging had a sensitivity of 81.2% in anterior circulation and 59.6% in posterior circulation stroke, both with good specificity (57.1% and 92.6%, respectively). 60% (6/10) of epileptic patients showed abnormal perfusion in CTP maps, which was inconsistent with cerebral arterial supply territories. Hypoperfusion manifestations were discovered in areas adjacent to occlusion sinus of all 3 CVST cases.

Conclusion

This retrospective study indicates WB-CTP can be useful in identifying acute ischemic stroke in emergency department, especially for patients with acute LAO stroke. Moreover, WB-CTP may have a value in differentiating stroke mimics such as epilepsy and CVST.

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Availability of data and material

Study related data and materials are accessible on request from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We thank all our fellow workers, residents and nursing team at the Department of Neurology in Shanghai East Hospital for their continuous support of this study.

Funding

This work was supported by grants obtained from the Shanghai Key Clinical Discipline (Grant No. shslczdzk06103), the Outstanding Leaders Training Program of Pudong New Area Health System of Shanghai (Grant No. PWRl2018-01), Shanghai Science and Technology Commission (Grant No. 16511105000–16511105002) and the Scientific Research Projects of Shanghai Health and Family Planning Commission (Grant No.201640388). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China

    Feifeng Liu, Xinyi Yang, Gang Li & Lian Zuo

  2. Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China

    Changlong Hou & Zhiyu Li

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  1. Feifeng Liu
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  2. Xinyi Yang
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  3. Changlong Hou
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  4. Zhiyu Li
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  5. Gang Li
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  6. Lian Zuo
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Contributions

LFF conceived and designed the study, wrote the first draft of the manuscript and analyzed the data. YXY carried out data collection. LZY, HCL and LG were responsible for the CTP assessment. ZL designed the study and finalized the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lian Zuo.

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The study was approved by the Ethics Committee of Shanghai East Hospital and the informed consent was obtained from the included patients.

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Liu, F., Yang, X., Hou, C. et al. Diagnostic value of whole-brain computed tomographic perfusion imaging for suspected large artery occlusion stroke patients in emergency department. Acta Neurol Belg 122, 1219–1227 (2022). https://doi.org/10.1007/s13760-021-01859-z

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  • DOI: https://doi.org/10.1007/s13760-021-01859-z

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