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Observational Study
. 2016 Apr;58(4):327-37.
doi: 10.1007/s00234-015-1636-z. Epub 2016 Jan 14.

CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Tom van Seeters  1 , Geert Jan Biessels  2 , L Jaap Kappelle  2 , Irene C van der Schaaf  3 , Jan Willem Dankbaar  3 , Alexander D Horsch  3 , Joris M Niesten  3 , Merel J A Luitse  3 , Charles B L M Majoie  4 , Jan Albert Vos  5 , Wouter J Schonewille  6 , Marianne A A van Walderveen  7 , Marieke J H Wermer  8 , Lucien E M Duijm  9 , Koos Keizer  10 , Joseph C J Bot  11 , Marieke C Visser  12 , Aad van der Lugt  13 , Diederik W J Dippel  14 , F Oskar H W Kesselring  15 , Jeannette Hofmeijer  16 , Geert J Lycklama À Nijeholt  17 , Jelis Boiten  18 , Willem Jan van Rooij  19 , Paul L M de Kort  20 , Yvo B W E M Roos  21 , Frederick J A Meijer  22 , C Constantijn Pleiter  23 , Willem P T M Mali  3 , Yolanda van der Graaf  24 , Birgitta K Velthuis  3 ; Dutch acute stroke study (DUST) investigators
Collaborators, Affiliations
Observational Study

CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Tom van Seeters et al. Neuroradiology. 2016 Apr.

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 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.

Keywords: CT angiography; CT perfusion; Infarct volume; Ischemic stroke; Prediction.

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Figures

Fig. 1
Fig. 1
Flowchart depicting the number of patients included in the study and remaining for the analyses
Fig. 2
Fig. 2
Example of a predicted risk of infarct presence and predicted infarct volume for an individual patient using an interactive calculation sheet
Fig. 3
Fig. 3
Infarct volume and clinical outcome. The range of mRS scores is depicted within patients with a large infarct, small infarct, or no infarct on follow-up imaging. Patients with an infarct on follow-up imaging were dichotomized at the median infarct volume (14.8 mL)
See this image and copyright information in PMC

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