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Observational Study
. 2025 Dec;46(12):6639-6649.
doi: 10.1007/s10072-025-08567-z. Epub 2025 Oct 29.

CT perfusion in the acute setting: a useful tool in the differential diagnosis of aphasic syndromes

Giovanni Furlanis  1 , Emanuele Vincis  2 , Edoardo Ricci  2 , Milos Ajčević  2   3 , Federica Palacino  2 , Gianpiero Farina  2 , Gabriele Prandin  2 , Laura Mancinelli  2 , Magda Quagliotto  2 , Alina Menichelli  4 , Paola Potente  2 , Martina Maset  2 , Paola Caruso  2 , Marcello Naccarato  2 , Maja Ukmar  5 , Paolo Manganotti  2
Affiliations
Observational Study

CT perfusion in the acute setting: a useful tool in the differential diagnosis of aphasic syndromes

Giovanni Furlanis et al. Neurol Sci. 2025 Dec.

Abstract

Introduction: Acute-onset aphasia is a common condition in ischemic stroke but it can also occur in other conditions defined as stroke mimics (SM). CT perfusion (CTP) is a radiological tool employed during the "stroke code" but its role in differentiating patients with stroke from those with SM is still under investigation. We aimed to evaluate the role of CTP in the differential diagnosis between stroke-related aphasia and SM-related aphasia in the acute setting.

Materials and methods: In this retrospective observational study conducted at Trieste University Hospital, we compared demographic, clinical, and imaging data of patients with stroke-related aphasia and patients with SM-related aphasia, differentiating the two groups according to the presence or absence of an ischemic lesion at the follow-up CT/MRI. Ischemic pattern was defined as regions of perfusion asymmetries following cerebral arteries' supply territories with MTT prolongation, decreased CBV, decreased CBF or summary map showing penumbra/core, while non-ischemic pattern was defined as regions of perfusion asymmetries not classifiable as ischemic pattern as stated above or as the absence of CTP asymmetries.

Results: Out of 140 patients analyzed, 116 (83%) received a final diagnosis of stroke-related aphasia, while 24 were diagnosed with SM-related aphasia (17%). MTT was the most useful CTP map in identifying an ischemic pattern in patients with stroke-related aphasia (detection rate 95.69%).

Discussion: CTP is an appropriate radiological tool for making an accurate etiological diagnosis in the context of aphasic syndromes. MTT map was found to be the most accurate in identifying an ischemic pattern.

Keywords: Aphasia; CT perfusion; CT-scan; Ischemic stroke; Stroke mimic.

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Conflict of interest statement

Declarations. Informed consent: Informed consent was obtained from all participants or their legal representatives. Ethical statement: The research was conducted according to the principles of the Declaration of Helsinki. This study was approved by the Local Ethics Committee CEUR (Comitato Etico Unico Regionale, FVG, Italy).

References

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