Comparative evaluation of CT perfusion and perfusion-weighted imaging in cerebral hemodynamics of cerebrovascular stenosis

Purpose This study compares Computed Tomography Perfusion (CTP) and Perfusion-Weighted Imaging (PWI) in assessing cerebral hemodynamics in patients with cerebrovascular stenosis and identifies key perfusion indicators associated with stenosis severity. Methods A retrospective analysis was conducted on 117 patients with unilateral internal carotid or middle cerebral artery stenosis/occlusion from January 2019 to June 2025. Patients were categorized into mild (n = 47) and severe (n = 70) stenosis groups based on DSA. CTP and PWI were used to measure cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC). Statistical analyses included t-tests, chi-square tests, multivariate logistic regression, and ROC curve analysis. Results Both CTP and PWI revealed significant hemodynamic alterations in the severe stenosis group, including reduced CBF and CBV, and prolonged MTT and TTP. Multivariate analysis, adjusted for clinical confounders, identified MTT from CTP (adjusted OR = 7.942, 95% CI: 2.845–21.892, P < 0.001) and CBF from PWI (adjusted OR = 0.512, 95% CI: 0.392–0.669, P < 0.001) as the strongest independent predictors of severe stenosis. ROC analysis showed good diagnostic accuracy for both modalities. ROC analysis based on combined multivariate models showed good diagnostic accuracy for both modalities (CTP model AUC = 0.813; PWI model AUC = 0.863), with no statistically significant difference between them ( p = 0.092, DeLong's test). No significant differences in cognitive function were observed. Conclusion Both CTP and PWI effectively assess hemodynamic impairment in cerebrovascular stenosis, with PWI showing marginally superior diagnostic accuracy. Parameters such as MTT and CBF are reliable indicators of stenosis severity and can aid in clinical decision-making.