Efficacy of dynamic CT perfusion imaging in conjunction with three dimensional CT angiography for the evaluation of acute ischemic stroke

BACKGROUND AND PURPOSE: Through the use of a high-speed spiral CT scanner (GEMedical HiSpeedZX/i), CT/P/A technique, where conventional CT, CT perfusion imaging (CTP) and CT angiography (CTA) are consecutively performed, can now be performed with an imaging time of 90 seconds and a total contrast medium volume of 100 ml. A prospective clinical study was performed to ascertain the effectiveness of CT/P/A in diagnosing acute ischemic strokes. METHODS: 29 consecutive patients of Teraoka Memorial Hospital suspected of suffering from the occlusion or constriction of cerebral arteries and who underwent CT/P/A within 3 hours from the onset served as subjects. The sensitivity, specificity, or Odds ratio of CTP and CTA in detecting lesions that caused cerebral infarction was calculated. RESULTS: CTP detected a hypoperfusion area with a sensitivity, specificity, and Odds ratio of 80%, 64%, and 7.2. The sensitivity in lobar infarcts, white matter infarcts, basal ganglia infarcts, and brainstem infarcts was 100%, 100%, 100%, 0% (p = 0.0022). The sensitivity and Odds ratio of CT/P/A in cerebral infarcts differed according to the diameter of the infarcts. That with infarcts of 10 mm or more was 91%, 20. That with infarcts smaller than 10 mm was 50%, 2. CTA detected arterial lesions that caused cerebral ischemic attack with a sensitivity of 94% and specificity of 90%. The examination time for CT/P/A was 18 minutes, total radiation time being 90 seconds. CONCLUSIONS: Although CT/P/A was ineffective for the diagnosis of brainstem infarcts and lesions smaller than 10 mm, CT/P/A was useful in detecting moderate-sized hypoperfusion areas and arterial lesions three-dimensionally before an infarct is completed.