Diagnostic Utility of Computed Tomography Perfusion in Acute Ischemic Stroke
Muhammad Khalid1, Muhammad Ayub1, Mohammad Sheikh1, Monika Thapa1, Pankaj Sharma1
1LSU Shreveport
Objective:
To assess the sensitivity and specificity of CTP compared with follow-up MRI in acute ischemic stroke.
Background:
CTP is highly sensitive and specific for anterior circulation large vessel occlusion (LVO), but its utility in distal medium vessel occlusion (DMVO) and small infarcts is questionable.
Design/Methods:
Data were collected from 115 cases of adult patients aged >18 presenting with acute strokes at our institution between 2020-2023. We included DMVO and non-LVO strokes. Non-LVO strokes comprise all patients without LVO and DMVO. Ischemia on initial CT perfusion scans was compared to strokes on follow-up MRI scans.
The analysis included descriptive statistical analysis as well as logistic regression models given a binary outcome variable. Logistic regression analyses were run of the main cohorts and a subgroup constituting individuals with DMVO and non-LVO strokes. The significance level was set at 0.05.
Results:
There were a total of 115 patients with a mean age of 62.36 with 49.57% males.
The sensitivity and specificity of initial CTP to detect strokes on subsequent MRI were 73.02% and 55.77%, respectively.
Univariate analysis revealed a statistically significant association between initial CTP and subsequent MRI for all patients (OR = 3.41; 95% CI: 1.56 – 7.45; p = 0.02). Multivariable analysis was statistically insignificant (OR = 1.62; 95% CI: 0.43 – 6.12; p = 0.48).
Univariate regression analysis of the non-LVO subgroup revealed a statistically insignificant association between initial CTP and subsequent MRI (OR = 1.42; 95% CI: 0.6 – 3.36; p = 0.42). Multivariable analysis also revealed insignificant results (OR = 1.07; 95% CI: 0.26 – 4.39; p = 0.92).
Conclusions:
We found a statistically significant association between CTP and MRI findings in the main cohorts during univariable analysis. However, the subgroup analysis showed a statistically nonsignificant difference. Further studies with larger sample sizes are needed to evaluate this association.
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