Cerebral perfusion CT: Technique and clinical applications

Wintermark, Max; Sincic, Ryan; Sridhar, Divya; Chien, Jeffrey D.

doi:10.1016/j.neurad.2008.03.005

Cited by 92 publications

(52 citation statements)

References 27 publications

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“…The hypoperfused areas on CBV maps with a threshold at <60% of the contralateral-side mean value were defined as the infarct core and delimited by hand-drawn ROIs [8,9,22]. CBV-derived infarct core volume was calculated in milliliters by multiplying ROIs by slice thickness.…”

Section: Methodsmentioning

confidence: 99%

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Increased Blood-Brain Barrier Permeability on Perfusion Computed Tomography Predicts Hemorrhagic Transformation in Acute Ischemic Stroke

et al. 2014

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Background/Purpose: Perfusion computed tomography (CT) is capable of measuring the permeability surface product (PS). PS reflects the permeability of the blood-brain barrier, involved in the pathophysiology of hemorrhagic transformation (HT) of ischemic stroke. The aim of our study was to determine if an increased PS can predict HT. Methods: A total of 86 patients with ischemic stroke were included. They underwent multimodality CT, including the measurement of PS. We compared the clinical and radiological characteristics of patients who developed HT to those who did not, using univariate analysis. Multivariate regression analyses were then used to determine HT predictors. Results: HT was observed in 27 patients (31%). Infarct PS was significantly associated with HT (p = 0.047), as were atrial fibrillation (p = 0.03), admission National Institute of Health Stroke Scale score (p = 0.02), infarct volume (p = 0.0004), presence of large-vessel occlusion (p = 0.0005) and a poorer collateral status (p = 0.003). Using logistic regression modeling, an infarct PS >0.84 ml/100 g/min was an independent predictor of HT (OR 28, 95% CI 1.75-452.98; p = 0.02). Other independent predictors of HT were infarct volume and a history of atrial fibrillation. Conclusions: Our findings suggest thatinfarct PS can be a predictor of HT and may help clinicians to improve patient care around thrombolysis decisions in the acute phase of ischemic stroke.

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Section: Methodsmentioning

confidence: 99%

“…PCT can distinguish between the infarct core and the penumbra using quantitative assessments of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT). Ischemic lesion volume derived from MTT maps and admission values for CBV have been reported to be strongly associated with HT [3,8,9]. …”

Section: Introductionmentioning

confidence: 99%

Increased Blood-Brain Barrier Permeability on Perfusion Computed Tomography Predicts Hemorrhagic Transformation in Acute Ischemic Stroke

et al. 2014

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“…Data acquisition protocols are outlined in the supplement. Raw perfusion data were post-processed using two algorithms, one based on standard deconvolution and the other on maximum slope method [27,28] to create CBF, CBV and TTP maps. High-resolution, NCCT images (1,036 × 776 pixels, rescaled to 72 dpi) were coupled with both sets of post-processed perfusion images (512 × 512 pixels, rescaled to 72 dpi) creating 80 imaging datasets.…”

Section: Methodsmentioning

confidence: 99%

Does Perfusion Computed Tomography Facilitate Clinical Decision Making for Thrombolysis in Unselected Acute Patients with Suspected Ischaemic Stroke?

et al. 2011

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Background: Despite use in clinical practice and major positive trials of thrombolysis, non-contrast computed tomography (NCCT) is not sensitive for identifying penumbral tissue in acute stroke. This study evaluated how physiological imaging using CT perfusion (CTP) could add to the diagnostic utility of an NCCT and inform clinical decisions regarding thrombolysis. Methods: Forty imaging datasets containing NCCT and CTP were retrospectively identified from a cohort of consecutive acute stroke patients. Two sets of observers (n = 6) and a neuroradiologist evaluated the images without knowledge of clinical symptoms. Inter-observer agreement was calculated using the ĸ statistic for identifying acute ischaemic change on NCCT: perfusion abnormalities (namely cerebral blood volume, cerebral blood flow and time to peak), and penumbral tissue on perfusion maps obtained by two image processing algorithms. Results: Inter-rater agreement was moderate (ĸ = 0.54) for early ischaemic change on NCCT. Perfusion maps improved this to substantial for cerebral blood volume (ĸ = 0.67) and to almost perfect for time to peak (ĸ = 0.87) and cerebral blood flow (ĸ = 0.87). The agreement for qualitative assessment of penumbral tissue was substantial to perfect for images obtained using the two different perfusion algorithms. Overall, there was a high rate of decision to thrombolyse based on NCCT (81.25%). CTP strengthened the decision to thrombolyse based on NCCT in 38.3% of cases. It negatively influenced the decision in 14.6% of cases, this being significantly more common in experienced observers (p = 0.02). Conclusions: We demonstrate that the qualitative evaluation of CTP produces near perfect inter-observer agreement, regardless of the post-processing method used. CTP is a reliable, accessible and practical imaging modality that improves confidence in reaching the appropriate diagnosis. It is particularly useful for less experienced clinicians, to arrive at a physiologically informed treatment decision.

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“…If initial non-contrast-enhanced cranial CT (NE-CCT) ruled out any form of intracranial hemorrhage and early signs of infarction (discrete parenchymal hypoattenuation, loss of cortical/subcortical or basal ganglia delineation, sulcal effacement) <1/3 of the MCA territory, CTA was performed. All examinations were carried out on a 16-row multislice CT scanner (Somatom Sensation 16, Siemens Medical System, Erlangen, Germany) according to previously described protocols [13,14]. CTA encompassed a volume from the level of the 6th cervical vertebra up to the vertex after administration of 80 ml of contrast agent (Visipaque 270®, GE Healthcare Buchler, Braunschweig, Germany) over an antecubital venous line, using a power injector (MedRad Medical Systems, Volbach, Germany) at a flow rate of 4 ml/s followed by a saline flush of 40 ml at the same flow rate, with semi-automated bolus tracking in the common carotid artery on the affected side at the level of the 6th vertebra.…”

Section: Methodsmentioning

confidence: 99%

CT-Angiographic Collateralization Predicts Final Infarct Volume after Intra-Arterial Thrombolysis for Acute Anterior Circulation Ischemic Stroke

Angermaier¹,

Langner

Kirsch

et al. 2010

Cerebrovasc Dis

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Background: Final infarct volume after thrombolysis for acute ischemic stroke depends on time to, and degree of reperfusion and residual blood flow, which is influenced by leptomeningeal collateralization. We evaluated the role of collateralization in the ischemic territory as a predictor of infarct size. Methods: Twenty-five patients (17 women, 8 men, mean age: 67.6 ± 12.4 years) selected by non-contrast-enhanced CT and CT angiography (CTA) underwent intra-arterial thrombolysis (iaT) within 6 h after symptom onset (mean 4.1 ± 1.3 h) for middle cerebral and terminal internal carotid artery (MCA/ICA) stroke. CTA was evaluated for collateralization using thick-slice coronal and axial maximum-intensity projection reconstructions according to a simple score, the CTA collateralization score (CTA-cs): 0 = no collateral filling, 1 = ≤50%, 2 = >50% but <100%, and 3 = 100% collateral filling. We analyzed the association between the final infarct volume on CT 5 days after the intervention and the CTA-cs, successful reperfusion (Thrombolysis in Myocardial Infarction, TIMI, grades 2 and 3) and time to treatment in a prospective study approved by our institutional review board, with informed consent from all patients. Results: Reperfusion was achieved in 72%. Asymptomatic and symptomatic parenchymal hemorrhage occurred in 2 patients (8%) each and hemorrhagic transformation in 4 (16%). CTA-cs (r = –0.63; p < 0.001) and postinterventional TIMI grade (r = –0.403; p = 0.046) were inversely associated with final infarct volume. After multiple regression analysis, CTA-cs and reperfusion remained as independent predictors of final infarct volume whereas time to treatment and initial stroke severity did not. Conclusion: The extent of collateralization and reperfusion are independent predictors of final infarct volume in acute MCA/ICA stroke treated with iaT. Time to treatment and stroke severity had no independent effect on final infarct volume.

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Cerebral perfusion CT: Technique and clinical applications

Cited by 92 publications

References 27 publications

Increased Blood-Brain Barrier Permeability on Perfusion Computed Tomography Predicts Hemorrhagic Transformation in Acute Ischemic Stroke

Increased Blood-Brain Barrier Permeability on Perfusion Computed Tomography Predicts Hemorrhagic Transformation in Acute Ischemic Stroke

Does Perfusion Computed Tomography Facilitate Clinical Decision Making for Thrombolysis in Unselected Acute Patients with Suspected Ischaemic Stroke?

CT-Angiographic Collateralization Predicts Final Infarct Volume after Intra-Arterial Thrombolysis for Acute Anterior Circulation Ischemic Stroke

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