Abstract
There is limited but growing research regarding the accuracy of CTP in diagnosing acute posterior ischemia stroke. We sought to evaluate the diagnostic accuracy of an incremental multimodal CT protocol in acute posterior ischemic stroke. Retrospective review of incremental NCCT, CTA-source images and CTP use in 82 consecutive patients with acute posterior ischemic stroke. Readers were blinded to infarct status on follow-up imaging (MRI or CT). Predictive effects of observed diagnostic accuracy and confidence score were quantified with the entropy r2 value. Sensitivity, specificity, and CI were calculated accounting for multiple reader assessments. Receiver Operating Characteristic analyses, including Area Under the Curve, were conducted for the three modalities. Inter-reader agreement was established with Intraclass Correlation Coefficient. Follow-up imaging confirmed infarct in 69/82 (84 %) patients. Multimodal protocol with CTP, outperforms CTA-source images and NCCT for correct acute posterior ischemia stroke diagnosis. The Area Under the Curve was 0.741 (95 % CI 0.708–0.773); 0.70 (95 % CI 0.663–0.731, P = 0.03) and 0.62 (95 % CI 0.588–0.659, P < 0.0001), respectively. Incrementally improved correlation between observed and actual diagnosis (r2 = 0.09, 0.26 and 0.32) and a higher rate of certainty (51.4, 69.3 and 81.7 %) was demonstrated for NCCT, CTA-source images and CTP respectively. Inter-reader agreement for the actual diagnosis was good and improved from 0.68 to 0.83 with incremental multimodal CT use. CTP enhances confident and correct infarct diagnosis over NCCT and CTA-source images in acute posterior ischemia stroke.
Highlights
There is limited but growing research regarding the accuracy of CT perfusion (CTP) in diagnosing acute posterior ischemia stroke
Acute posterior ischemia stroke accounts for 20 % of ischemic stroke [1] and is most commonly cardioembolic followed by large-artery atherosclerosis [2]
A multimodal CT protocol including targeted posteriorfossa CTP improved acute posterior ischemic stroke diagnosis over Non contrast CT (NCCT) alone or a combination of NCCT/ CT angiography (CTA)-SI supporting the addition of CTP to stroke protocols using only NCCT and CTA-source image (CTA-SI)
Summary
There is limited but growing research regarding the accuracy of CTP in diagnosing acute posterior ischemia stroke. We sought to evaluate the diagnostic accuracy of an incremental multimodal CT protocol in acute posterior ischemic stroke. Advances in CT such as a table-toggle technique or increase detector number [13], facilitate more extensive brain coverage with increasing visualization of the posterior fossa. This extended coverage is not yet widely available. The purpose of this study was to assess the predictive value of each component (NCCT, CTA-SI and CTP) of an incremental CT protocol using targeted posterior fossa CTP for the assessment of posterior ischemic stroke presentation
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