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Research paper
CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke
  1. Bruce C V Campbell1,2,
  2. Louise Weir1,3,
  3. Patricia M Desmond2,
  4. Hans T H Tu1,
  5. Peter J Hand1,
  6. Bernard Yan1,
  7. Geoffrey A Donnan4,
  8. Mark W Parsons5,
  9. Stephen M Davis1
  1. 1Departments of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  2. 2Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  3. 3Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
  4. 4Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
  5. 5Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Bruce Campbell, Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia; bruce.campbell{at}mh.org.au

Abstract

Background and objective CT perfusion (CTP) is rapid and accessible for emergency ischaemic stroke diagnosis. The feasibility of introducing CTP and diagnostic accuracy versus non-contrast CT (NCCT) in a tertiary hospital were assessed.

Methods All patients presenting <9 h from stroke onset or with wake-up stroke were eligible for CTP (Siemens 16-slice scanner, 2×24 mm slabs) unless they had estimated glomerular filtration rate (eGFR)<50 ml/min or diabetes with unknown eGFR. NCCT was assessed by a radiologist and stroke neurologist for early ischaemic change and hyperdense arteries. CTP was assessed for prolonged time to peak and reduced cerebral blood flow. Technical adequacy was defined as 2 CTP slabs of sufficient quality to diagnose stroke.

Results Between January 2009 and September 2011, 1152 ischaemic stroke patients were admitted, 475 (41%) were <9 h/wake-up onset. Of these, 276 (58%) had CTP. Reasons for not performing CTP were diabetes with unknown eGFR (48 (10%)), known kidney disease (36 (8%)), established infarct on NCCT (27 (6%)), posterior circulation syndrome (25 (5%)) and patient motion/instability (16 (3%)). Clinician discretion excluded a further 47 (10%). CTP was more frequently diagnostic than NCCT (80% vs 50%, p<0.001). Non-diagnostic CTP was due to lacunar infarction (28 (10%)), infarct outside slab coverage (21 (8%)), technical failure (4 (1%)) and reperfusion (2 (0.7%)). Normal CTP in 86/87 patients with stroke mimics supported withholding tissue plasminogen activator. CTP technical adequacy improved from 56% to 86% (p<0.001) after the first 6 months. Median time for NCCT/CTP/arch-vertex CT angiogram (including processing and interpretation) was 12 min. No clinically significant contrast nephropathy occurred.

Conclusions CTP in suspected stroke is widely applicable, rapid and increases diagnostic confidence.

  • Stroke
  • Cerebrovascular Disease

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