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CT perfusion in acute stroke.

Khandelwal N - Indian J Radiol Imaging (2008)

Bottom Line: Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction.Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity.This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Sector 12, Chandigarh, India.

ABSTRACT
Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.

No MeSH data available.


Related in: MedlinePlus

Initial NCCT (A) (at 1.5 h from stroke onset) showing hyperdense left MCA (black arrow), loss of insular ribbon (white open arrow), and obscuration with subtle hypodensity of the left lentiform nucleus (curved arrow). CTA volume-rendered images (B) show complete occlusion of the left intracranial ICA and M1 segment (black arrow on the right); note poor filling of the distal MCA branches, possibly through leptomeningeal collaterals (white arrow in the left image). Color-coded perfusion maps (C) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic core—umbra—with mirror ROI (black arrow) in the contralateral hemisphere; relative values for CBF, CBV, and MTT are shown as a percentage of normal hemispheres (left hand bottom corner of each map). Time–attenuation curve showing lack of contrast arrival peak in the ROI on the affected side (arrow head). Color-coded perfusion maps (D) for CBF, CBV, and MTT- ROI (white arrows) placed in the ischemic penumbra, with mirror ROI (black arrows) in the contralateral hemisphere. The values (left hand bottom corner of each map) of rCBF and rCBV are greater, and rMTT lesser, than those in the umbra (see C). Post-thrombolysis CTA volume-rendered image (E) showing partial recanalization of the left cavernous ICA (black arrow) with occluded supraclinoid ICA and M1 segment and better filling of distal MCA branches (white arrow) as compared to the pre-thrombolysis CTA (see B). Color-coded perfusion maps (F) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic penumbra, with mirror ROI (black arrow) in the contralateral hemisphere. rCBF and rCBV values are higher than the pre-thrombolysis values (left hand bottom corner of each map). However, there is no significant change in the size of the penumbra as compared to the prethrombolysis perfusion CT
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Figure 0008: Initial NCCT (A) (at 1.5 h from stroke onset) showing hyperdense left MCA (black arrow), loss of insular ribbon (white open arrow), and obscuration with subtle hypodensity of the left lentiform nucleus (curved arrow). CTA volume-rendered images (B) show complete occlusion of the left intracranial ICA and M1 segment (black arrow on the right); note poor filling of the distal MCA branches, possibly through leptomeningeal collaterals (white arrow in the left image). Color-coded perfusion maps (C) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic core—umbra—with mirror ROI (black arrow) in the contralateral hemisphere; relative values for CBF, CBV, and MTT are shown as a percentage of normal hemispheres (left hand bottom corner of each map). Time–attenuation curve showing lack of contrast arrival peak in the ROI on the affected side (arrow head). Color-coded perfusion maps (D) for CBF, CBV, and MTT- ROI (white arrows) placed in the ischemic penumbra, with mirror ROI (black arrows) in the contralateral hemisphere. The values (left hand bottom corner of each map) of rCBF and rCBV are greater, and rMTT lesser, than those in the umbra (see C). Post-thrombolysis CTA volume-rendered image (E) showing partial recanalization of the left cavernous ICA (black arrow) with occluded supraclinoid ICA and M1 segment and better filling of distal MCA branches (white arrow) as compared to the pre-thrombolysis CTA (see B). Color-coded perfusion maps (F) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic penumbra, with mirror ROI (black arrow) in the contralateral hemisphere. rCBF and rCBV values are higher than the pre-thrombolysis values (left hand bottom corner of each map). However, there is no significant change in the size of the penumbra as compared to the prethrombolysis perfusion CT

Mentions: The role of NCCT, CTA, and CTP is highlighted in the illustrative example in Figure 8.


CT perfusion in acute stroke.

Khandelwal N - Indian J Radiol Imaging (2008)

Initial NCCT (A) (at 1.5 h from stroke onset) showing hyperdense left MCA (black arrow), loss of insular ribbon (white open arrow), and obscuration with subtle hypodensity of the left lentiform nucleus (curved arrow). CTA volume-rendered images (B) show complete occlusion of the left intracranial ICA and M1 segment (black arrow on the right); note poor filling of the distal MCA branches, possibly through leptomeningeal collaterals (white arrow in the left image). Color-coded perfusion maps (C) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic core—umbra—with mirror ROI (black arrow) in the contralateral hemisphere; relative values for CBF, CBV, and MTT are shown as a percentage of normal hemispheres (left hand bottom corner of each map). Time–attenuation curve showing lack of contrast arrival peak in the ROI on the affected side (arrow head). Color-coded perfusion maps (D) for CBF, CBV, and MTT- ROI (white arrows) placed in the ischemic penumbra, with mirror ROI (black arrows) in the contralateral hemisphere. The values (left hand bottom corner of each map) of rCBF and rCBV are greater, and rMTT lesser, than those in the umbra (see C). Post-thrombolysis CTA volume-rendered image (E) showing partial recanalization of the left cavernous ICA (black arrow) with occluded supraclinoid ICA and M1 segment and better filling of distal MCA branches (white arrow) as compared to the pre-thrombolysis CTA (see B). Color-coded perfusion maps (F) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic penumbra, with mirror ROI (black arrow) in the contralateral hemisphere. rCBF and rCBV values are higher than the pre-thrombolysis values (left hand bottom corner of each map). However, there is no significant change in the size of the penumbra as compared to the prethrombolysis perfusion CT
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 0008: Initial NCCT (A) (at 1.5 h from stroke onset) showing hyperdense left MCA (black arrow), loss of insular ribbon (white open arrow), and obscuration with subtle hypodensity of the left lentiform nucleus (curved arrow). CTA volume-rendered images (B) show complete occlusion of the left intracranial ICA and M1 segment (black arrow on the right); note poor filling of the distal MCA branches, possibly through leptomeningeal collaterals (white arrow in the left image). Color-coded perfusion maps (C) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic core—umbra—with mirror ROI (black arrow) in the contralateral hemisphere; relative values for CBF, CBV, and MTT are shown as a percentage of normal hemispheres (left hand bottom corner of each map). Time–attenuation curve showing lack of contrast arrival peak in the ROI on the affected side (arrow head). Color-coded perfusion maps (D) for CBF, CBV, and MTT- ROI (white arrows) placed in the ischemic penumbra, with mirror ROI (black arrows) in the contralateral hemisphere. The values (left hand bottom corner of each map) of rCBF and rCBV are greater, and rMTT lesser, than those in the umbra (see C). Post-thrombolysis CTA volume-rendered image (E) showing partial recanalization of the left cavernous ICA (black arrow) with occluded supraclinoid ICA and M1 segment and better filling of distal MCA branches (white arrow) as compared to the pre-thrombolysis CTA (see B). Color-coded perfusion maps (F) for CBF, CBV, and MTT- ROI (white arrow) placed in the ischemic penumbra, with mirror ROI (black arrow) in the contralateral hemisphere. rCBF and rCBV values are higher than the pre-thrombolysis values (left hand bottom corner of each map). However, there is no significant change in the size of the penumbra as compared to the prethrombolysis perfusion CT
Mentions: The role of NCCT, CTA, and CTP is highlighted in the illustrative example in Figure 8.

Bottom Line: Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction.Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity.This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Sector 12, Chandigarh, India.

ABSTRACT
Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.

No MeSH data available.


Related in: MedlinePlus