TY - JOUR
T1 - CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke
AU - van Seeters, Tom
AU - Biessels, Geert Jan
AU - Kappelle, L. Jaap
AU - van der Schaaf, Irene C.
AU - Dankbaar, Jan Willem
AU - Horsch, Alexander D.
AU - Niesten, Joris M.
AU - Luitse, Merel J A
AU - Majoie, Charles B L M
AU - Vos, Jan Albert
AU - Schonewille, Wouter J.
AU - van Walderveen, Marianne A A
AU - Wermer, Marieke J H
AU - Duijm, Lucien E M
AU - Keizer, Koos
AU - Bot, Joseph C J
AU - Visser, Marieke C.
AU - van der Lugt, Aad
AU - Dippel, Diederik W J
AU - Kesselring, F. Oskar H W
AU - Hofmeijer, Jeannette
AU - Lycklama à Nijeholt, Geert J.
AU - Boiten, Jelis
AU - van Rooij, Willem Jan
AU - de Kort, Paul L M
AU - Roos, Yvo B W E M
AU - Meijer, Frederick J A
AU - Pleiter, C. Constantijn
AU - Mali, Willem P T M
AU - van der Graaf, Yolanda
AU - Velthuis, Birgitta K.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - 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.
AB - 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.
KW - CT angiography
KW - CT perfusion
KW - Infarct volume
KW - Ischemic stroke
KW - Prediction
UR - https://www.scopus.com/pages/publications/84954320028
U2 - 10.1007/s00234-015-1636-z
DO - 10.1007/s00234-015-1636-z
M3 - Article
C2 - 26767380
SN - 0028-3940
VL - 58
SP - 327
EP - 337
JO - Neuroradiology
JF - Neuroradiology
IS - 4
ER -