RT Journal Article
SR Electronic
T1 Multimodal CT Provides Improved Performance for Lacunar Infarct Detection
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1069
OP 1075
DO 10.3174/ajnr.A4255
VO 36
IS 6
A1 T. Das
A1 F. Settecase
A1 M. Boulos
A1 T. Huynh
A1 C.D. d'Esterre
A1 S.P. Symons
A1 L. Zhang
A1 R.I. Aviv
YR 2015
UL http://www.ajnr.org/content/36/6/1069.abstract
AB BACKGROUND AND PURPOSE: Lacunar 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 METHODS: Institutional 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 r2 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.RESULTS: The 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).CONCLUSIONS: CTP offers an improved diagnostic benefit over NCCT and CTA for the diagnosis of lacunar infarction.AICAkaike information criterionCTA-SICT angiographic–source imagesIQRinterquartile rangeLIlacunar infarct