Triphasic Perfusion Computed Tomography in Acute Middle Cerebral Artery Stroke

Abstract

Triphasic perfusion computed tomography is useful for diagnosing proximal MCA occlusion and assessing perfusion deficit and collateral circulation as reliably as DSA. The zone of severe perfusion deficit on TPCT may be presumed to be the ischemic core, and that of moderate perfusion deficit, the penumbra zone. Triphasic perfusion computed tomography may be used as a rapid and noninvasive tool to make thrombolysis safer.

Distal hyperintense vessels on FLAIR

“…18,19 Other imaging modalities like MRI, CT, and transcranial Doppler can be used to evaluate collateral blood flow. [20][21][22] Based on our findings and reported cases, 1,12 we suggest that distal HV in patients with MCA occlusion results from collateral blood flow originating in neighboring arterial territories, especially via pial collaterals.…”

Distal hyperintense vessels on FLAIR

“…18,19 Other imaging modalities like MRI, CT, and transcranial Doppler can be used to evaluate collateral blood flow. [20][21][22] Based on our findings and reported cases, 1,12 we suggest that distal HV in patients with MCA occlusion results from collateral blood flow originating in neighboring arterial territories, especially via pial collaterals.…”

Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:

“…In patients with MCA occlusion, a small PWCT abnormality is considered an indicator of better leptomeningeal collateral blood flow, which promotes survival of ischemic brain tissue until reperfusion occurs. 13, 21 We also report that in this homogeneous, highly selected patient group, initial PWCT lesion volume is a stronger overall predictor of clinical outcome than is admission NIHSS score, especially for those with successful recanalization. In comparison, patients with partial recanalization demonstrate enlargement of their initial PWCT lesion volume on follow-up imaging, and clinical outcome is more likely to be worse.…”

Multiphasic Helical Computed Tomography Predicts Subsequent Development of Severe Brain Edema in Acute Ischemic Stroke

“…Other vascular territory involvement was defined as hypodensity or perfusion deficits (moderate and severe perfusion deficit) in the anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. We also determined the presence of proximal MCA (stem, bifurcation, and divisions) and internal carotid artery occlusion with hyperdense arterial signs on precontrast CT and nonenhancing segments on early-and middle-phase images of multiphasic helical CT. 9,10 We obtained agreement rates and values between the 2 readers. The readers agreed on the extent of parenchymal hypodensities in 27 of 32 patients ( = 0.78) and severe perfusion deficits in 29 (=0.91).…”

Distal hyperintense vessels on FLAIR

“…18,19 Other imaging modalities like MRI, CT, and transcranial Doppler can be used to evaluate collateral blood flow. [20][21][22] Based on our findings and reported cases, 1,12 we suggest that distal HV in patients with MCA occlusion results from collateral blood flow originating in neighboring arterial territories, especially via pial collaterals.…”

Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:

“…In patients with MCA occlusion, a small PWCT abnormality is considered an indicator of better leptomeningeal collateral blood flow, which promotes survival of ischemic brain tissue until reperfusion occurs. 13, 21 We also report that in this homogeneous, highly selected patient group, initial PWCT lesion volume is a stronger overall predictor of clinical outcome than is admission NIHSS score, especially for those with successful recanalization. In comparison, patients with partial recanalization demonstrate enlargement of their initial PWCT lesion volume on follow-up imaging, and clinical outcome is more likely to be worse.…”

Multiphasic Helical Computed Tomography Predicts Subsequent Development of Severe Brain Edema in Acute Ischemic Stroke

“…Other vascular territory involvement was defined as hypodensity or perfusion deficits (moderate and severe perfusion deficit) in the anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. We also determined the presence of proximal MCA (stem, bifurcation, and divisions) and internal carotid artery occlusion with hyperdense arterial signs on precontrast CT and nonenhancing segments on early-and middle-phase images of multiphasic helical CT. 9,10 We obtained agreement rates and values between the 2 readers. The readers agreed on the extent of parenchymal hypodensities in 27 of 32 patients ( = 0.78) and severe perfusion deficits in 29 (=0.91).…”

Distal hyperintense vessels on FLAIR

“…18,19 Other imaging modalities like MRI, CT, and transcranial Doppler can be used to evaluate collateral blood flow. [20][21][22] Based on our findings and reported cases, 1,12 we suggest that distal HV in patients with MCA occlusion results from collateral blood flow originating in neighboring arterial territories, especially via pial collaterals.…”

Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:

“…In patients with MCA occlusion, a small PWCT abnormality is considered an indicator of better leptomeningeal collateral blood flow, which promotes survival of ischemic brain tissue until reperfusion occurs. 13, 21 We also report that in this homogeneous, highly selected patient group, initial PWCT lesion volume is a stronger overall predictor of clinical outcome than is admission NIHSS score, especially for those with successful recanalization. In comparison, patients with partial recanalization demonstrate enlargement of their initial PWCT lesion volume on follow-up imaging, and clinical outcome is more likely to be worse.…”

Multiphasic Helical Computed Tomography Predicts Subsequent Development of Severe Brain Edema in Acute Ischemic Stroke

“…Other vascular territory involvement was defined as hypodensity or perfusion deficits (moderate and severe perfusion deficit) in the anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. We also determined the presence of proximal MCA (stem, bifurcation, and divisions) and internal carotid artery occlusion with hyperdense arterial signs on precontrast CT and nonenhancing segments on early-and middle-phase images of multiphasic helical CT. 9,10 We obtained agreement rates and values between the 2 readers. The readers agreed on the extent of parenchymal hypodensities in 27 of 32 patients ( = 0.78) and severe perfusion deficits in 29 (=0.91).…”