Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2010 Mar 2

PMID 20190208

Citations 36

Authors

Y W Lui

E R Tang

A M Allmendinger

V Spektor

Affiliations

Soon will be listed here.

Abstract

CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.

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References

Wintermark M, Meuli R, Browaeys P, Reichhart M, Bogousslavsky J, Schnyder P . Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment. Neurology. 2007; 68(9):694-7. DOI: 10.1212/01.wnl.0000255959.30107.08. View

Sanelli P, Lev M, Eastwood J, Gonzalez R, Lee T . The effect of varying user-selected input parameters on quantitative values in CT perfusion maps. Acad Radiol. 2004; 11(10):1085-92. DOI: 10.1016/j.acra.2004.07.002. View

Schramm P, Schellinger P, Fiebach J, Heiland S, Jansen O, Knauth M . Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. Stroke. 2002; 33(10):2426-32. DOI: 10.1161/01.str.0000032244.03134.37. View

Schramm P, Schellinger P, Klotz E, Kallenberg K, Fiebach J, Kulkens S . Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours' duration. Stroke. 2004; 35(7):1652-8. DOI: 10.1161/01.STR.0000131271.54098.22. View

Srinivasan A, Goyal M, Al Azri F, Lum C . State-of-the-art imaging of acute stroke. Radiographics. 2006; 26 Suppl 1:S75-95. DOI: 10.1148/rg.26si065501. View

Nguyen T, Lum C, Eastwood J, Stys P, Hogan M, Goyal M . Hyperperfusion on perfusion computed tomography following revascularization for acute stroke. Acta Radiol. 2005; 46(6):610-5. DOI: 10.1080/02841850510021607. View

Parsons M, Pepper E, Chan V, Siddique S, Rajaratnam S, Bateman G . Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol. 2005; 58(5):672-9. DOI: 10.1002/ana.20638. View

Huang B, Castillo M . Radiological reasoning: extracranial causes of unilateral decreased brain perfusion. AJR Am J Roentgenol. 2007; 189(6 Suppl):S49-54. DOI: 10.2214/AJR.07.7030. View

Royter V, Paletz L, Waters M . Stroke vs. status epilepticus. A case report utilizing CT perfusion. J Neurol Sci. 2007; 266(1-2):174-6. DOI: 10.1016/j.jns.2007.08.038. View

10.

Marchal G, Young A, Baron J . Early postischemic hyperperfusion: pathophysiologic insights from positron emission tomography. J Cereb Blood Flow Metab. 1999; 19(5):467-82. DOI: 10.1097/00004647-199905000-00001. View

11.

Hellier K, Hampton J, Guadagno J, Higgins N, Antoun N, Day D . Perfusion CT helps decision making for thrombolysis when there is no clear time of onset. J Neurol Neurosurg Psychiatry. 2006; 77(3):417-9. PMC: 2077703. DOI: 10.1136/jnnp.2005.067363. View

12.

Lin K, Rapalino O, Law M, Babb J, Siller K, Pramanik B . Accuracy of the Alberta Stroke Program Early CT Score during the first 3 hours of middle cerebral artery stroke: comparison of noncontrast CT, CT angiography source images, and CT perfusion. AJNR Am J Neuroradiol. 2008; 29(5):931-6. PMC: 8128574. DOI: 10.3174/ajnr.A0975. View

13.

Majoie C, van Boven L, van de Beek D, Venema H, Van Rooij W . Perfusion CT to evaluate the effect of transluminal angioplasty on cerebral perfusion in the treatment of vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2007; 6(1):40-4. PMC: 2782106. DOI: 10.1385/ncc:6:1:40. View

14.

Mori S, Endo M, Nishizawa K, Murase K, Fujiwara H, Tanada S . Comparison of patient doses in 256-slice CT and 16-slice CT scanners. Br J Radiol. 2006; 79(937):56-61. DOI: 10.1259/bjr/39775216. View

15.

Murray A, Staff R, Shenkin S, Deary I, Starr J, Whalley L . Brain white matter hyperintensities: relative importance of vascular risk factors in nondemented elderly people. Radiology. 2005; 237(1):251-7. DOI: 10.1148/radiol.2371041496. View

16.

OSullivan M, Lythgoe D, Pereira A, Summers P, Jarosz J, Williams S . Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis. Neurology. 2002; 59(3):321-6. DOI: 10.1212/wnl.59.3.321. View

17.

Eastwood J, Lev M, Wintermark M, Fitzek C, Barboriak D, DeLong D . Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke. AJNR Am J Neuroradiol. 2003; 24(9):1869-75. PMC: 7976307. View

18.

Kang K, Kim H, Kim S . Quantitative cerebrovascular reserve measured by acetazolamide-challenged dynamic CT perfusion in ischemic adult Moyamoya disease: initial experience with angiographic correlation. AJNR Am J Neuroradiol. 2008; 29(8):1487-93. PMC: 8119064. DOI: 10.3174/ajnr.A1129. View

19.

Rai A, Carpenter J, Peykanu J, Popovich T, Hobbs G, Riggs J . The role of CT perfusion imaging in acute stroke diagnosis: a large single-center experience. J Emerg Med. 2008; 35(3):287-92. DOI: 10.1016/j.jemermed.2007.08.071. View

20.

Schaefer P, Barak E, Kamalian S, Gharai L, Schwamm L, Gonzalez R . Quantitative assessment of core/penumbra mismatch in acute stroke: CT and MR perfusion imaging are strongly correlated when sufficient brain volume is imaged. Stroke. 2008; 39(11):2986-92. DOI: 10.1161/STROKEAHA.107.513358. View