A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous
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ORIGINAL ARTICLE
A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic Antonio Granato 1 & Laura D’Acunto 1 & Miloš Ajčević 1,2 & Giovanni Furlanis 1 & Maja Ukmar 3 & Roberta Antea Pozzi Mucelli 3 & Paolo Manganotti 1 Received: 2 February 2020 / Accepted: 20 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke. Methods We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant. Results Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold. Conclusions Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke. Keywords Migraine . CT perfusion imaging . Cerebrovascular disease . Stroke mimics . Image processing
Antonio Granato, Laura D’Acunto, Miloš Ajčević and Giovanni Furlanis contributed equally to this work. * Laura D’Acunto [email protected] Antonio Granato [email protected]
Paolo Manganotti [email protected] 1
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste ASUGI, University of Trieste, Strada di fiume, 447 –, 34149 Trieste, Italy
2
Department of Engineering and Architecture, University of Trieste, Trieste, Italy
3
Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of TriesteASUGI, University of Trieste, Trieste, Italy
Miloš Ajčević [email protected] Giovanni Furlanis [email protected] Maja Ukmar [email protected] Roberta Antea Pozzi Mucelli roberta.pozzimucelli@g
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