Abstract
IntroductionWe investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging.MethodsWe analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP.ResultsAt follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001).ConclusionIn the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00234-015-1636-z) contains supplementary material, which is available to authorized users.
Highlights
Introduction We investigated whether baselineCT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging
We showed that CTA and CTP measures were strong predictors of clinical outcome [17], though in multivariable prediction models, their prognostic value in addition to easier-to-obtain measures, i.e., patient characteristics and noncontrast CT (NCCT), was limited
Our study shows that CTA and CTP have additional value over patient characteristics and NCCT for predicting infarct presence and infarct volume on follow-up imaging
Summary
CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The AUC of 0.82 (95 % confidence interval (CI) 0.79– 0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures In patients with clinical features of acute ischemic stroke, the underlying cause should be identified and different treatment options should be weighed in order to start optimal treatment as quickly as possible. 16 Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
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