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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1390501
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 76 articles

YIELD OF COMPUTED TOMOGRAPHY PERFUSION IN STROKE MANAGEMENT

Provisionally accepted
Martina Cviková Martina Cviková 1,2*Michal Haršány Michal Haršány 1,2Jan Vinklárek Jan Vinklárek 1,3Jakub Stefela Jakub Stefela 1,2Iva Fojtová Iva Fojtová 1Robert Mikulík Robert Mikulík 1,3,4
  • 1 Saint Anne University hospital, Brno, Czechia
  • 2 Faculty of Medicine, Masaryk University, Brno, South Moravia, Czechia
  • 3 Masaryk University, Brno, South Moravia, Czechia
  • 4 International Clinical Research Center (FNUSA-ICRC), Brno, South Moravia, Czechia

The final, formatted version of the article will be published soon.

    Guidelines do not support the use of computed tomography perfusion (CTP) unless it is used to diagnose penumbra in extended time window treatment. This study aimed to define the yield of CTP for stroke diagnosis beyond penumbra imaging in the hyperacute phase (0-6 hours) and extended time window (6-24 hours).All consecutive patients with acute onset of symptoms within a 24-hour window underwent CTP. The diagnostic value of CTP was calculated against the clinical and radiological diagnosis of stroke. CTP was positive in the presence of core or penumbra on RAPID. Clinical diagnoses were discharge diagnoses of stroke. Radiological diagnosis was established if early ischemic changes (ASPECTs < 10) on baseline CT scan, acute infarction on follow-up imaging, or symptomatic occlusion on baseline CT angiography was present.Between Nov/2018-Nov/2019, 585 consecutive patients with acute neurological deficit were scanned with multimodal CT imaging; 500 (85%) were included: 274 (55%) within the hyperacute phase, 153 (31%) had radiological diagnoses of stroke, and 122 (24%) clinical diagnoses of stroke. CTP was positive only in patients with confirmed stroke (positive predictive value and specificity 100%). When CTP was negative, 43% had a stroke mimic. Patients with stroke mimics were younger (6617 vs. 7313) and had lower National Institutes of Health Stroke Scale (median 0; IQR 0-2 vs. median 4; IQR 2-6) compared to patients with CTP negative stroke.In stroke management, CTP is most useful if it is positive because in our study, it always meant brain ischemia. Positive CTP should prompt adequate stroke management without delay. If CTP is negative, both stroke and non-stroke diagnoses need to be considered.

    Keywords: CT perfusion, Stroke, stroke mimics, stroke imaging, Acute management of stroke

    Received: 23 Feb 2024; Accepted: 25 Jul 2024.

    Copyright: © 2024 Cviková, Haršány, Vinklárek, Stefela, Fojtová and Mikulík. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Martina Cviková, Saint Anne University hospital, Brno, Czechia

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