Affiliation:
1. St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University
2. International Clinical Research Center of St. Anne's University Hospital Brno
Abstract
Abstract
OBJECTIVES
The use of computed tomography perfusion (CTP) is not supported by guidelines unless to diagnose penumbra in extended time window treatment. The purpose of this study was to define the yield of CTP for stroke diagnosis beyond penumbra imaging in hyperacute phase (0-6 hours) and extented time window (6-24 hours).
MATERIALS AND METHODS
All consecutive patients with acute onset of symptoms within 24-hour window underwent CTP. The diagnostic value of CTP was calculated against radiological and clinical diagnosis of stroke. CTP was positive in presence of core or penumbra on RAPID. Radiological diagnoses were established as acute infarction on follow up imaging or symptomatic occlusion on baseline CT angiography. Clinical diagnoses were discharge diagnoses of stroke.
RESULTS
BetweenNov/2018-Nov/2019, 585 consecutive patients with acute neurological deficit were scanned with multimodal CT imaging, 500 (85%) were included: 274 (55%) within hyperacute phase, 153 (31%) had radiological diagnoses of stroke, and 122 (24%) clinical diagnoses of stroke. CTP was positive only in patients with confirmed stroke (positive predictive value and specificity 100%). When CTP was negative, 43% had a stroke mimic. Patients with stroke mimics were younger (66±17 vs. 73±13) and had lower National Institutes of Health Stroke Scale (median 0; IQR 0-2 vs median 4; IQR 2-6) compared to patients with CTP negative stroke.
CONCLUSIONs: Our study newly documents that CTP is useful beyond penumbra imaging: if CTP is positive than stroke diagnosis is established, which should prompt acute recanalization treatments. If CTP is negative physicians should consider stroke mimics.
Publisher
Research Square Platform LLC
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