ArticleAJNR. American journal of neuroradiology2015
Multimodal CT provides improved performance for lacunar infarct detection.
Article in AJNR. American journal of neuroradiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 33 citations in OpenAlex.
- Regional Reliability of Combining CT Angiography-source Image and Non-contrast CT in Acute Ischemic Stroke.International journal of medical sciences · 2024Article
- Improved Visualization and Quantification of Net Water Uptake in Recent Small Subcortical Infarcts in the Thalamus Using Computed Tomography.Diagnostics (Basel, Switzerland) · 2023Article
- CT Perfusion in Lacunar Stroke: A Systematic Review.Diagnostics (Basel, Switzerland) · 2023Review
- Optimal CT perfusion thresholds for core and penumbra in acute posterior circulation infarction.Frontiers in neurology · 2023Article
- The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke.International journal of molecular sciences · 2022Review
- Association of compromised cerebral perfusion with lenticulostriate artery impairments in the subacute phase of branch atheromatous disease.Therapeutic advances in neurological disorders · 2022Article
- Multimodal CT in Acute Stroke.Current neurology and neuroscience reports · 2019Review
- Effect of Clinical History on Interpretation of Computed Tomography for Acute Stroke.The Neurohospitalist · 2019Article
- Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2019Article
- Article
- CT Perfusion in Acute Lacunar Stroke: Detection Capabilities Based on Infarct Location.AJNR. American journal of neuroradiology · 2016Article
- Perfusion-weighted imaging and dynamic 4D angiograms for the estimation of collateral blood flow in lacunar infarction.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2016Article
- Examining Subcortical Infarcts in the Era of Acute Multimodality CT Imaging.Frontiers in neurology · 2016Article
- CT perfusion can delineate lacunar infarcts in acute stroke calls.Neurology. Clinical practice · 2015Article
- Cerebral small vessel disease and Alzheimer's disease.Clinical interventions in aging · 2015Review
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeLacunar infarcts account for approximately 25% of acute ischemic strokes. Compared with NCCT alone, the addition of CTP improves sensitivity for detection of infarcts overall. Our aim was to systematically evaluate the diagnostic benefit and interobserver reliability of an incremental CT protocol in lacunar infarction. MATERIALS AND
methodsInstitutional review board approval and patient consent were obtained. One hundred sixty-three patients presenting with a lacunar syndrome ≤4.5 hours from symptom onset were enrolled. Images were reviewed incrementally by 2 blinded readers in 3 separate sessions (NCCT only, NCCT/CTA, and NCCT/CTA/CTP). Diagnostic confidence was recorded on a 6-point scale with DWI/ADC as a reference. Logistic regression analysis calculated differences between actual and observed diagnoses, adjusted for confidence. Predictive effects of observed diagnostic accuracy and confidence score were quantified with the entropy r(2) value. Sensitivity, specificity, and confidence intervals were calculated accounting for multiple readers. Receiver operating characteristic analyses were compared among diagnostic strategies. Interobserver agreement was established with Cohen κ statistic.
resultsThe final study cohort comprised 88 patients (50% male). DWI/ADC-confirmed lacunar infarction occurred in 59/88 (67%) with 36/59 (61%) demonstrating a concordant abnormal finding on CTP. Sensitivity for definite or probable presence of lacunar infarct increased significantly from 9.3% to 42.4% with incremental protocol use, though specificity was unchanged (range, 91.9%-95.3%). The observed diagnosis was significantly related to the actual diagnosis after adjusting for CTP confidence level (P = .04) and was 5.1 and 2.4 times more likely to confirm lacunar infarct than NCCT or CTA source images. CTP area under the curve (0.77) was significantly higher than that of CTA source images (0.68, P = .006) or NCCT (0.55, P < .001).
conclusionsCTP offers an improved diagnostic benefit over NCCT and CTA for the diagnosis of lacunar infarction.
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