CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke
van Seeters, Tom; Biessels, Geert Jan; Kappelle, L. Jaap; van der Schaaf, Irene C.; Dankbaar, Jan Willem; Horsch, Alexander D.; Niesten, Joris M.; Luitse, Merel J A; Majoie, Charles B L M; Vos, Jan Albert; Schonewille, Wouter J.; van Walderveen, Marianne A A; Wermer, Marieke J H; Duijm, Lucien E M; Keizer, Koos; Bot, Joseph C J; Visser, Marieke C.; van der Lugt, Aad; Dippel, Diederik W J; Kesselring, F. Oskar H W; Hofmeijer, Jeannette; Lycklama à Nijeholt, Geert J.; Boiten, Jelis; van Rooij, Willem Jan; de Kort, Paul L M; Roos, Yvo B W E M; Meijer, Frederick J A; Pleiter, C. Constantijn; Mali, Willem P T M; van der Graaf, Yolanda; Velthuis, Birgitta K.
(2016) Neuroradiology, volume 58, issue 4, pp. 327 - 337
(Article)
Abstract
INTRODUCTION: We 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. METHODS: We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent
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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 R (2) was assessed to determine the additional value of CTA and CTP. RESULTS: At 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 (R (2) = 0.58) was superior to patient characteristics and non-contrast CT alone (R (2) = 0.44) and to addition of CTA alone (R (2) = 0.55) or CTP alone (R (2) = 0.54; all p < 0.001). CONCLUSION: In 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.
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Keywords: CT angiography, CT perfusion, Infarct volume, Ischemic stroke, Prediction, Radiology Nuclear Medicine and imaging, Clinical Neurology, Cardiology and Cardiovascular Medicine, Journal Article, Research Support, Non-U.S. Gov't, Multicenter Study, Observational Study
ISSN: 0028-3940
Publisher: Springer Verlag
(Peer reviewed)