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7 COMPUTED TOMOGRAPHY ANGIOGRAPHY SOURCE IMAGES ARE MORE ACCURATE THAN UNENHANCED COMPUTED TOMOGRAPHY FOR THE DETECTION AND DELINEATION OF ACUTE ISCHEMIC LESIONS: RECEIVER OPERATOR CHARACTERISTIC CURVE ANALYSIS USING A MODIFIED ASPECTS RATING SCALE.
  1. E. C. Camargo,
  2. K. L. Furie,
  3. A. B. Singhal,
  4. L. Roccatagliata,
  5. M. E. Cunnane,
  6. E. F. Halpern,
  7. G. J. Harris,
  8. W. S. Smith,
  9. R. G. Gonzalez,
  10. W. J. Koroshetz,
  11. M. H. Lev
  1. Harvard University, Boston, MA; *San Francisco, CA

Abstract

Purpose ASPECTS is a robust method for quantifying acute stroke hypodensity on noncontrast CT (NCCT) and helps predict clinical outcome. Whole brain source images obtained with CT angiography (CTA-SI) may increase ischemic brain conspicuity. We sought to determine if CTA-SI is more sensitive than NCCT in detecting acute middle cerebral artery (MCA) infarction and in predicting final infarct size using a modified ASPECT score for lesion delineation.

Materials and Methods After informed consent, we reviewed NCCT and CTA-SI scans of 51 patients with suspected MCA stroke, imaged within 12 hours of symptoms onset, enrolled in a dual-center cohort study. Two blinded neuroimagers rated presence and extent of NCCT and CTA-SI hypodensity using modified ASPECTS. Level of certainty for hypodensity detection was graded on admission and follow-up images using a 5-point scale (5 = definitely present; 1 = definitely absent). Linear regression and receiver operator characteristic (ROC) analyses were performed.

Results Thirty-three patients had confirmed infarction at follow-up (mean 6.5 days). Using certainty levels $ 4 (probable/definite) for ischemic hypodensity, sensitivity for acute stroke detection was 49% with NCCT and 70% with CTA-SI (p = .04, ROC analysis); specificity was 100% for both. Linear regression showed R 2 = .42 (p < .0001) for the correlation between acute NCCT modified ASPECTS and follow-up modified ASPECTS, and .73 (p < .0001) for the correlation between CTA-SI and follow-up modified ASPECTS (p < .0001 for the NCCT/CTA-SI comparison). Conclusion: CTA-SI, compared to NCCT, is more sensitive in detecting early irreversible ischemia and more accurate for final infarct volume prediction using modified ASPECTS.

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