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Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

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).

Methods

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.

Results

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.

Conclusion

CTP may improve sensitivity and specificity of cortical involvement for post-stroke seizures compared to NCCT.

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Authors and Affiliations

  1. Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia

    Miriam Koome, Ziyuan Chen, Ziyi Chen, Jillian Naylor, Arthur Thevathasan, Bernard Yan & Patrick Kwan

  2. Florey Neuroscience Institutes, Austin Health, University of Melbourne, Melbourne, Australia

    Leonid Churilov

  3. School of Medicine, Tsinghua University, Beijing, China

    Ziyuan Chen

  4. First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China

    Ziyi Chen

  5. Department of Medicine, The University of Melbourne, Melbourne, Australia

    Jillian Naylor & Patrick Kwan

Authors
  1. Miriam Koome
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  2. Leonid Churilov
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  3. Ziyuan Chen
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  4. Ziyi Chen
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  5. Jillian Naylor
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  6. Arthur Thevathasan
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  7. Bernard Yan
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  8. Patrick Kwan
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Corresponding authors

Correspondence to Bernard Yan or Patrick Kwan.

Ethics declarations

We declare that all human and animal studies have been approved by the Melbourne Health Human Research Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Koome, M., Churilov, L., Chen, Z. et al. Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke. Neuroradiology 58, 577–584 (2016). https://doi.org/10.1007/s00234-016-1670-5

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  • DOI: https://doi.org/10.1007/s00234-016-1670-5

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