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Title: Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke.
Austin Authors: Koome, Miriam;Churilov, Leonid ;Chen, Ziyuan;Chen, Ziyi;Naylor, Jillian;Thevathasan, Arthur;Yan, Bernard;Kwan, Patrick
Affiliation: Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
Florey Neuroscience Institutes, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
School of Medicine, Tsinghua University, Beijing, China
First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
Department of Medicine, The University of Melbourne, Melbourne, Australia
Issue Date: Jun-2016 2016-03-09
Publication information: Neuroradiology 2016; 58(6): 577-584
Abstract: Cerebral cortical ischemia is a risk factor for post-stroke seizures. However, the optimal imaging method is unclear. We investigated CT perfusion (CTP) in detecting cortical ischemia and its correlation with post-stroke seizures compared with non-contrast CT (NCCT). We included patients with acute ischemic stroke admitted to the Royal Melbourne Hospital between 2009 and 2014. Post-stroke seizure information was collected. Cortical involvement was determined on acute NCCT and CTP (T max, cerebral blood volume [CBV], and cerebral blood flow [CBF]). The association between cortical involvement detected by different imaging modalities and post-stroke seizures was examined. Three-hundred fifty-two patients were included for analysis. Fifty-nine percent were male, and median age was 73 years (inter-quartile range 61-82). Follow-up was available for 96 %; median follow-up duration was 377 days (inter-quartile range 91-1018 days). Thirteen patients had post-stroke seizures (3.9 %). Cortical involvement was significantly associated with post-stroke seizures across all modalities. CBV had the highest hazard ratio (11.3, 95 % confidence interval (CI) 1.1-41.2), followed by NCCT (5.3, 95 % CI 1.5-18.0) and CBF (4.2, 95 % CI 1.1-15.2). Sensitivity was highest for T max (100 %), followed by CBV and CBF (both 76.9 %) and NCCT (63.6 %). Specificity was highest for CBV (77.8 %), then NCCT (75.6 %), CBF (54.0 %), and T max (29.1 %). Receiver-operating characteristic area under the curve was significantly different between imaging modalities (p < 0.001), CBV 0.77, NCCT 0.70, CBF 0.65, and T max 0.65. CTP may improve sensitivity and specificity of cortical involvement for post-stroke seizures compared to NCCT.
DOI: 10.1007/s00234-016-1670-5
ORCID: 0000-0002-9807-6606
PubMed URL: 26961195
PubMed URL:
Type: Journal Article
Subjects: CT perfusion
Ischaemic Stroke
Non-contrast CT
Post-Stroke epilepsy
Appears in Collections:Journal articles

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