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Review
. 2023 Apr 27;13(9):1564.
doi: 10.3390/diagnostics13091564.

CT Perfusion in Lacunar Stroke: A Systematic Review

Marialuisa Zedde  1 , Manuela Napoli  2 , Ilaria Grisendi  1 , Federica Assenza  1 , Claudio Moratti  2 , Franco Valzania  1 , Rosario Pascarella  2
Affiliations
Review

CT Perfusion in Lacunar Stroke: A Systematic Review

Marialuisa Zedde et al. Diagnostics (Basel). .

Abstract

Background: The main theory underlying the use of perfusion imaging in acute ischemic stroke is the presence of a hypoperfused volume of the brain downstream of an occluded artery. Indeed, the main purpose of perfusion imaging is to select patients for endovascular treatment. Computed Tomography Perfusion (CTP) is the more used technique because of its wide availability but lacunar infarcts are theoretically outside the purpose of CTP, and limited data are available about CTP performance in acute stroke patients with lacunar stroke.

Methods: We performed a systematic review searching in PubMed and EMBASE for CTP and lacunar stroke with a final selection of 14 papers, which were examined for data extraction and, in particular, CTP technical issues and sensitivity, specificity, PPV, and NPV values.

Results: A global cohort of 583 patients with lacunar stroke was identified, with a mean age ranging from 59.8 to 72 years and a female percentage ranging from 32 to 53.1%.CTP was performed with different technologies (16 to 320 rows), different post-processing software, and different maps. Sensitivity ranges from 0 to 62.5%, and specificity from 20 to 100%.

Conclusions: CTP does not allow to reasonable exclude lacunar infarct if no perfusion deficit is found, but the pathophysiology of lacunar infarct is more complex than previously thought.

Keywords: CTP; MRI; RSSI; SVD; lacuna; lacunar stroke; perfusion; recent small subcortical infarct; small vessel disease; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram. *, 10 case reports, 10 papers about nonlacunar stroke, seven studies not using CTP, four papers not pertinent to stroke, two replies, two pictorial or narrative reviews, two conference abstracts, one animal model. **. There are nine studies without data con CTP in lacunar stroke, six studies on nonlacunar stroke, five narrative reviews, three papers focused on technical protocol, two conference abstracts, two systematic reviews not focused on lacunar stroke, 1 study protocol, one letter without new data.
See this image and copyright information in PMC

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