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(Stroke. 2004;35:1652.)
© 2004 American Heart Association, Inc.

Original Contributions

Comparison of Perfusion Computed Tomography and Computed Tomography Angiography Source Images With Perfusion-Weighted Imaging and Diffusion-Weighted Imaging in Patients With Acute Stroke of Less Than 6 Hours’ Duration

Peter Schramm, MD; Peter D. Schellinger, MD; Ernst Klotz, PhD; Kai Kallenberg, MD; Jochen B. Fiebach, MD; Sonja Külkens, MD; Sabine Heiland, PhD; Michael Knauth, MD Klaus Sartor, MD

From the Departments of Neuroradiology (P.S., J.B.F., S.H., K.S.) and Neurology (P.D.S., S.K.), University of Heidelberg Medical School, Germany; NINDS (P.D.S.), NIH, Bethesda, Md; Siemens Medical Solutions (E.K.), Forchheim, Germany; and Department of Neuroradiology (K.K., M.K.), University of Göttingen Medical School, Germany.

Correspondence to Peter Schramm, MD, Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail peter_schramm{at}med.uni-heidelberg.de

Background and Purpose— We aimed to determine the diagnostic value of perfusion computed tomography (PCT) and CT angiography (CTA) including CTA source images (CTA-SI) in comparison with perfusion-weighted magnetic resonance imaging (MRI) (PWI) and diffusion-weighted MRI (DWI) in acute stroke <6 hours.

Methods— Noncontrast-enhanced CT, PCT, CTA, stroke MRI, including PWI and DWI, and MR angiography (MRA), were performed in patients with symptoms of acute stroke lasting <6 hours. We analyzed ischemic lesion volumes on patients’ arrival as shown on NECT, PCT, CTA-SI, DWI, and PWI (Wilcoxon, Spearman, Bland-Altman) and compared them to the infarct extent as shown on day 5 NECT.

Results— Twenty-two stroke patients underwent CT and MRI scanning within 6 hours. PCT time to peak (PCT-TTP) volumes did not differ from PWI-TTP (P=0.686 for patients who did not undergo thrombolysis/P=0.328 for patients who underwent thrombolysis), nor did PCT cerebral blood volume (PCT-CBV) differ from PWI-CBV (P=0.893/P=0.169). CTA-SI volumes did not differ from DWI volumes (P=0.465/P=0.086). Lesion volumes measured in PCT maps significantly correlated with lesion volumes on PWI (P=0.0047, r=1.0/P=0.0019, r=0.897 for TTP; P=0.0054, r=0.983/P=0.0026, r=0.871 for CBV). Also, PCT-CBV lesion volumes significantly correlated with follow-up CT lesion volumes (P=0.0047, r=1.0/P=0.0046, r=0.819).

Conclusions— In hyperacute stroke, the combination of PCT and CTA can render important diagnostic information regarding the infarct extent and the perfusion deficit. Lesions on PCT-TTP and PCT-CBV do not differ from lesions on PWI-TTP and PWI-CBV; lesions on CTA source images do not differ from lesions on DWI. The combination of noncontrast-enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA) can render additional information within <15 minutes and may help in therapeutic decision-making if PWI and DWI are not available or cannot be performed on specific patients.

Key Words: stroke, acute • perfusion • computed tomography • angiography • magnetic resonance imaging

Related Article:

Editorial Comment—Specificity of Stroke Imaging: Disregarded and Neglected

Rüdiger von Kummer
Stroke 2004 35: 1657-1658. [Full Text] [PDF]

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