64-Slice spiral CT perfusion combined with vascular imaging of acute ischemic stroke for assessment of infarct core and penumbra

Bao,Dang-Zhen; Bao,Huan-Ying; Yao,Li-Zhai; Pan,Yun-Gao; Zhu,Xin‑Rui; Yang,Xiao-Song; Wang,He; Huang,Yi-Ning

doi:10.3892/etm.2013.1107

64-Slice spiral CT perfusion combined with vascular imaging of acute ischemic stroke for assessment of infarct core and penumbra

Authors:
- Dang-Zhen Bao
- Huan-Ying Bao
- Li-Zhai Yao
- Yun-Gao Pan
- Xin‑Rui Zhu
- Xiao-Song Yang
- He Wang
- Yi-Ning Huang
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Affiliations: Department of Neurology, Nanle Rehabilitation Hospital, Puyang, Henan 457400, P.R. China, Department of Neurology, Nanle Central Hospital, Puyang, Henan 457400, P.R. China, Department of Neurology and Medical Imaging, Peking University First Hospital, Beijing 100034, P.R. China
Published online on: May 9, 2013 https://doi.org/10.3892/etm.2013.1107
Pages: 133-139

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Abstract

The aim of this study was to determine the value of computed tomography perfusion (CTP) parameters, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time-to-peak (TP), in a clinical study of patients with stroke. Additionally, we determined which parameter or combination of parameters are reliable in detecting the presence of an infarct and penumbra. CTP was performed within 24 h of the onset of symptoms in 20 patients with possible stroke. Magnetic resonance imaging (MRI) was performed 3-7 days later and the threshold of the CTP was adjusted according to the results to provide CT images that correlated with the MRI; the MRI results were taken as the gold standard. CBV, CBF and TP contrast agent enhancement were calculated using the CT results. The CTP results were compared with the MRI findings. All CTP parameters were reliable in detecting the penumbra (P<0.001). In these parameters, changes of MTT were the most useful. CTP revealed various changes in CBF, CBV, MTT and TP in ischemic areas. CTP parameters were also reliable in detecting the infarct core (P<0.001). We determined that when detecting the penumbra, all CTP parameters are reliable, and when detecting cerebral ischemia, a combination of parameters should be used.

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1.	Schramm P, Schellinger PD, Klotz E, et al: 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. 35:1652–1658. 2004.PubMed/NCBI
2.	Schramm P, Schellinger PD, Fiebach JB, et al: Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. Stroke. 33:2426–2432. 2002.PubMed/NCBI
3.	Wintermark M, Fischbein NJ, Smith WS, Ko NU, Quist M and Dillon WP: Accuracy of dynamic perfusion CT with decon¬volution in detecting acute hemispheric stroke. AJNR Am J Neuroradiol. 26:104–112. 2005.
4.	Wintermark M, Reichhart M, Cuisenaire O, et al: Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion weighted magnetic resonance imaging in acute stroke patients. Stroke. 33:2025–2031. 2002. View Article : Google Scholar
5.	Wintermark M, Reichhart M, Thiran JP, et al: Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol. 51:417–432. 2002. View Article : Google Scholar : PubMed/NCBI
6.	Astrup J, Siesjö BK and Symon L: Thresholds in cerebral ischemia - the ischemic penumbra. Stroke. 12:723–725. 1981. View Article : Google Scholar : PubMed/NCBI
7.	Hossmann KA: Neuronal survival and revival during and after cerebral ischemia. Am J Emerg Med. 1:191–197. 1983. View Article : Google Scholar : PubMed/NCBI
8.	Ingall TJ, O’Fallon WM, Louis TA, et al: Initial findings of the rt-PA acute stroke treatment review panel. Cerebrovasc Dis. 16(Suppl 4): S1–S125. 2003.
9.	Hacke W, Donnan G, Fieschi C, et al; ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators: Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 363:768–774. 2004. View Article : Google Scholar : PubMed/NCBI
10.	Schellinger PD and Warach S: Therapeutic time window of thrombolytic therapy following stroke. Curr Atheroscler Rep. 6:288–294. 2004. View Article : Google Scholar : PubMed/NCBI
11.	Mayer TE, Hamann GF, Baranczyk J, et al: Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol. 21:1441–1449. 2000.PubMed/NCBI
12.	Reichenbach JR, Röther J, Jonetz-Mentzel L, et al: Acute stroke evaluated by time-to-peak mapping during initial and early follow-up perfusion CT studies. AJNR Am J Neuroradiol. 20:1842–1850. 1999.PubMed/NCBI
13.	Latchaw RE, Yonas H, Hunter GJ, et al; Council on Cardiovascular Radiology of the American Heart Association: Guidelines and recommendations for perfusion imaging in cerebral ischemia: A scientific statement for healthcare professionals by the writing group on perfusion imaging, from the Council on Cardiovascular Radiology of the American Heart Association. Stroke. 34:1084–1104. 2003. View Article : Google Scholar
14.	Eastwood JD, Lev MH, Wintermark M, et al: Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke. AJNR Am J Neuroradiol. 24:1869–1875. 2003.PubMed/NCBI
15.	Eastwood JD, Lev MH, Azhari T, et al: CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke. Radiology. 222:227–236. 2002. View Article : Google Scholar : PubMed/NCBI
16.	Koenig M, Klotz E, Luka B, Venderink DJ, Spittler JF and Heuser L: Perfusion CT of the brain: diagnostic approach for early detection of ischemic stroke. Radiology. 209:85–93. 1998. View Article : Google Scholar : PubMed/NCBI
17.	Wintermark M, Flanders AE, Velthuis B, et al: Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 37:979–985. 2006. View Article : Google Scholar
18.	Wintermark M and Bogousslavsky J: Imaging of acute ischemic brain injury: the return of computed tomography. Curr Opin Neurol. 16:59–63. 2003. View Article : Google Scholar : PubMed/NCBI
19.	Barber PA, Hill MD, Eliasziw M, et al: Imaging of the brain in acute ischemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry. 76:1528–1533. 2005. View Article : Google Scholar : PubMed/NCBI
20.	Rai AT, Carpenter JS, Peykanu JA, Popovich T, Hobbs GR and Riggs JE: The role of CT perfusion imaging in acute stroke diagnosis: a large single-center experience. J Emerg Med. 35:287–292. 2008. View Article : Google Scholar : PubMed/NCBI
21.	Na DG, Ryoo JW, Lee KH, et al: Multiphasic perfusion computed tomography in hyperacute ischemic stroke: comparison with diffusion and perfusion magnetic resonance imaging. J Comput Assist Tomogr. 27:194–206. 2003. View Article : Google Scholar : PubMed/NCBI
22.	Nabavi DG, Cenic A, Craen RA, et al: CT assessment of cerebral perfusion: experimental validation and initial clinical experience. Radiology. 213:141–149. 1999. View Article : Google Scholar : PubMed/NCBI