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Kim, Lee, Kim, and Kim: Comparison of Diagnostic Usefulness of Multi-Channel CT Perfusion and Conventional Brain CT in the Acute Pontine Infarct
Neuroradiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2013; 68(1): 9-16.

Published online: 29 January 2013

DOI: https://doi.org/10.3348/jksr.2013.68.1.9

Comparison of Diagnostic Usefulness of Multi-Channel CT Perfusion and Conventional Brain CT in the Acute Pontine Infarct

Sung A Kim, MD, Myeong Sub Lee, MD, Myung Soon Kim, MD, Young Ju Kim, MD

Department of Radiology, Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea.

Corresponding author: Myung Soon Kim, MD. Department of Radiology, Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 220-701, Korea. Tel. 82-33-741-1462, Fax. 82-33-732-8281, kim0328@yonsei.ac.kr

Received 12 October 2012       Accepted 23 October 2012

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

CT perfusion (CTP) is an important modality in the diagnosis of acute stroke, and the range of its use is gradually expanding from supratentorial to whole brain stroke. We assessed the diagnostic value of multichannel CTP in comparison with conventional CT (CT) in acute pontine infarct.

Materials and Methods

CTP and follow-up diffusion weighted magnetic resonance imaging were performed in 74 patients diagnosed with acute pontine infarct among 178 suspicious ones. Diagnostic accuracy of CTP and CT was evaluated and quantitative analysis was performed to define the factors that may influence the detection rate.

Results

In the diagnosis of acute pontine infarct, the sensitivity, specificity, and accuracy of CTP was 56.8%, 91.4%, and 77.0% and of conventional CT scan was 47.3%, 93.3%, and 74.2%, respectively. There was no statistically significant difference. Receiver operation characteristic curve revealed both types of imaging to have diagnostic usefulness (p < 0.01) in acute pontine infarct. Among the factors that may affect the detection rate, infarct volume was found to be statistically significant (CTP: p < 0.01, CT: p = 0.01).

Conclusion

This is the first study that analyzed the difference between CTP and CT in the diagnostic accuracy of acute pontine infarction. Both CTP and CT are useful diagnostic tools although CTP seems to have a slightly higher detection rate than CT.

Keywords: Acute Pontine Infarction, Multidetector CT Perfusion, Conventional CT, Diffusion Weighted Magnetic Resonance Imaging

Figures and Tables

Fig. 1
Toggling table technique.
A. The scanner obtains images during a single rotation at location upper half location of the object.
B. Table moves upward to locate the lower half of the object under the X-ray tube.
C. Scanner obtains images during a single rotation at location.
D. Table moves 4 cm in the opposite direction to the original position.
E. Second cycle of scanning is repeated.
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Fig. 2
A case of abnormal finding on conventional CT, but not identified by CTP in right pontine infarction. Three days before examination, this 66-year-old man experienced dysarthria and left side weakness.
A, B. Early conventional CT scans show abnormal hypodensity (arrow) in the right pons (A: precontrast CT scan, B: enhanced CT scan).
C. All CTP maps confirm the absence of perfusion abnormality in the right pons.
D. Follow-up DWI of MRI, obtained 1 day after stroke, shows infarction (arrow) in the former ischemic portion of the right anteromedial pons. infarct volume: 0.501 mL, diffusion restriction value: 1893.3 (mean).
Note.-CBF = cerebral bloodflow, CBV = cerebral blood volume, CTP = CT perfusion, DWI = diffusion weighted imaging, MTT = mean transit time
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Fig. 3
A case of positive abnormal finding on CTP and but not identified by conventional CT in right pontine infarction. One day before examination, this 51-year-old man experienced dysarthria and left side weakness.
A, B. Early conventional CT scans appear normal in the right pons (A: precontrast CT scan, B: enhanced CT scan).
C. All CTP maps show perfusion abnormality (arrow) in the right pons.
D. Follow-up DWI of MRI, obtained 1 day after stroke, shows infarction (arrow) in the former ischemic portion of the right anteromedial pons. infarct volume: 0.976 mL, diffusion restriction value: 669.5 (mean).
Note.-CBF = cerebral blood flow, CBV = cerebral blood volume, CTP = CT perfusion, DWI = diffusion weighted imaging, MTT = mean transit time
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Fig. 4
Volumetric measurement of the infarct lesion. Boundary of the lesion was drawn and then the volume of the area was automatically calculated.
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Table 1
Comparison of Sensitivity, Specificity, and Accuracy between CTP and CT (n = 178)
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The McNemar test showed significant differences at p < 0.05.

Note.-CT = conventional CT, CTP = CT perfusion, FN = false negative, FP = false positive, TN = true negative, TP = true positive

Table 2
Relative Factors of Abnormal Positive Findings of CTP
jksr-68-9-i002

The ROC curve showed significant differences at p < 0.05.

Note.-CBF = map of cerebral blood flow, CBV = map of cerebral blood volume, CT = conventional CT, CTP = CT perfusion, DWMRI = diffusion weighted MR imaging, MTT = mean transit time, N = negative finding, P = positive finding

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