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01-09-2004 | Diagnostic Neuroradiology

Perfusion CT and angio CT in the assessment of acute stroke

Authors: J. M. Esteban, V. Cervera

Published in: Neuroradiology | Issue 9/2004

Abstract

In order to evaluate the clinical utility of non-enhanced CT with perfusion and angio CT in the assessment of acute ischaemic stroke, 42 patients with symptoms of acute stroke were examined within the first 6 h from onset of symptoms with non-enhanced CT (NECT), perfusion CT (PCT) and CT angiography (CTA). Maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analysed visually, and after drawing regions of interest (ROIs) in the territory of anterior, middle and posterior cerebral arteries, maximum-intensity projection and volume-rendering images of the cervical and cerebral vessels were created. All patients underwent a control CT or MR examination 24–48 h after the initial examination. Twenty-nine patients developed an area of infarction at control examinations. Significant perfusion abnormalities were found in 27 cases, whilst in two patients the perfusion studies were considered to be normal. All the cases with perfusion abnormalities showed arterial stenoses or occlusions on angio CT. Small infarctions at levels other than the ones selected for perfusion CT, and arteriosclerotic changes, were observed in the two cases with no perfusion abnormalities. In conclusion, combining non-enhanced CT with PCT and CTA is a simple and a very valuable tool in the initial assessment of acute stroke.

Lövblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, Warach S (1998) Clinical experience with diffusion-weighted MR in patients with acute stroke. Am J Neuroradiol 19:1061–1066PubMed

von Kummer R, Bourquain H, Bastianello S, Bozzao L, Manelfe C, Meier D, Hacke W (2001) Early prediction of irreversible brain damage after ischemic stroke at CT. Radiology 219:95–100PubMed

Grotta JC, Chiu D, Lu M, Patel S, Levine SR, Tilley BC, Brott TC, Haley EC, Lyden PD, Khotari R, Frankel M, Lewandowski CA, Libman R, Kwiatkowski T, Broderick JP, Marler JR, Corrigan J, Huff S, Mitsias P, Talati S, Tanne D (1999) Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy. Stroke 30:1528–1533PubMed

Kalafut MA, Schriger DL, Saver JL, Starkman S (2000) Detection of early CT signs of >1/3 middle cerebral artery infarctions : interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care. Stroke 31(7):1667–1671PubMed

Cumming MJ, Morrow IM (1994) Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. AJR Am J Roentgenol 163:517–523

Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W (1998) Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 29:935–938PubMed

Klotz E, König M (1999) Perfusion measurements of the brain: using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke. Eur J Radiol 30:170–184CrossRefPubMed

König M, Klotz E, Luka B, Venderink DJ, Spittler JF, Heuser L (1998) Perfusion CT of the brain: diagnostic approach for early detection of ischemic stroke. Radiology 209:85–93PubMed

Koenig M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L (2001) Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke 32:431–437PubMed

10.

Nabavi DG, Cenic A, Henderson S, Gelb AW, Lee T-Y (2001) Perfusion mapping using computed tomography allows accurate prediction of cerebral infarction in experimental brain ischemia. Stroke. 32(1):175–183

11.

Rother J, Jonetz-Mentzel L, Fiala A, Reichenbach JR; Herzau M, Kaiser WA, Weiller C (2000) Hemodynamic assessment of acute stroke using dynamic single-slice computed tomographic perfusion imaging. Arch Neurol 57:1161–1166CrossRefPubMed

12.

Mayer TE, Hamman GF, Baranczyk J, Rosengarten B, Klotz E, Wiesmann M, Missler U, Schulte-Altedomeburg G, Brueckmann HJ (2000) Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol. 21:1441–1449

13.

Eastwood JD, Lev MH, Azhari T, Lee T-Y, Barboriak DP, Delong DM, Fitzek C, Herzau M, Wintermark M, Meuli R, Brazier D, Provenzale JM(2002) CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke. Radiology 222:227–236PubMed

14.

Tomandl BF, Klotz E, Handschu R, Stemper B, Reinhardt F, Huk WJ, Eberhardt KE, Fateh-Moghadam S (2003) Comprehensive imaging of ischemic stroke with multisection CT. Radiographics 23:565–592PubMed

15.

Tomura N, Uemura K, Inugami A, Fujita H, Higano S, Shishido F (1988) Early CT finding in cerebral infarction: obscuration of the lentiform nucleus. Radiology 168:463–467PubMed

16.

Truwit CL, Barkovich AJ, Gean-Marton A, Hibri N, Norman D (1990) Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology 176:801–806PubMed

17.

Schuierer G, Hulk W (1988) The unilateral hyperdense middle cerebral artery: an early CT sign of embolism or thrombosis. Neuroradiology 30:120–122PubMed

18.

Leenders KL, Perani D, Lammertsma AA, Heather JD, Buckingham P, Healey MJ, Gibbs JM, Wise RJ, Hatazawa J, Herold S et al (1990) Cerebral blood flow, blood volume and oxygen utilization. Normal values and effect of age. Brain 113:27–47PubMed

19.

Latchaw RE, Yonas H, Hunter GJ, Yuh WTC, Ueda T, Sorensen AG, Sunshine JL, Biller J, Wechsler L, Higashida R, Hademenos G (2003) Guidelines and recommendations for perfusion imaging in cerebral ischemia. Stroke 34:1084–1104CrossRefPubMed

20.

Yonas H, Pindzola RR, Meltzer CC, Sasser H (1998) Qualitative versus quantitative assessment of cerebrovascular reserves. Neurosurgery 42:1005–1012PubMed

21.

Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW (1993) Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 79:483–489PubMed

22.

Astrup J, Symon L, Branston MN, Lassen NA (1977) Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke 8:51–57PubMed

23.

Mies G, Ishimaru S, Xie Y, Seo K, Hossmann KA (1991) Ischemic thresholds of cerebral protein synthesis and energy state following middle cerebral artery occlusion in rat. J Cereb Blood Flow Metab 11:753–761PubMed

24.

Phan TG, Wright PM, Markus R, Howells DW, Davis SM, Donnan GA (2002) Salvaging the ischaemic penumbra: more than just reperfusion? Clin Exp Pharmacol Physiol 29:1-10CrossRefPubMed

25.

Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J, Meuli R (2002) Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 51:417–432CrossRefPubMed

Title: Perfusion CT and angio CT in the assessment of acute stroke
Authors: J. M. Esteban
V. Cervera
Publication date: 01-09-2004
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 9/2004
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-004-1235-x

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