Improving Acute Stroke Management with Computed Tomography Perfusion: A Review of Imaging Basics and Applications
- PDF / 1,744,696 Bytes
- 16 Pages / 595.276 x 790.866 pts Page_size
- 64 Downloads / 200 Views
REVIEW ARTICLE
Improving Acute Stroke Management with Computed Tomography Perfusion: A Review of Imaging Basics and Applications C. D. d’Esterre & Enrico Fainardi & R. I. Aviv & T. Y. Lee
Received: 15 March 2012 / Revised: 9 April 2012 / Accepted: 12 April 2012 / Published online: 24 May 2012 # Springer Science+Business Media, LLC 2012
Abstract The inclusion of dynamic contrast-enhanced computed tomography (CT) or CT perfusion (CTP) scan into the imaging workup for acute stroke patients is widespread. Along with vessel occlusion status from CT angiography, CTP provides pathophysiological information a noncontrast CT cannot provide during the hyperacute stages of cerebral ischemia. Measurement of parenchymal perfusion at the capillary level can be used to characterize tissue viability, a target for thrombolysis. Further, CTP is useful for the detection of blood brain barrier disturbances with the permeability surface area product parameter (PS). Although new to stroke imaging, PS has diagnostic and prognostic C. D. d’Esterre : T. Y. Lee Lawson Health Research Institute, Western University, London, ON, Canada C. D. d’Esterre : T. Y. Lee Department of Medical Biophysics, Western University, London, ON, Canada T. Y. Lee Department of Medical Imaging, Western University, London, ON, Canada E. Fainardi Department of Neurosciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, Ferrara, Italy R. I. Aviv Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada T. Y. Lee (*) Imaging Research Lab, Robarts Research Institute, 100 Perth Drive, London, ON, Canada N6A 5K8 e-mail: [email protected]
implications for primary hemorrhage and secondary hemorrhagic transformation of ischemic stroke. The purpose of this article is to provide an overview of the CTP imaging concepts and their uses for imaging in stroke. Keywords Computed tomography perfusion . Acute stroke . Cerebral blood flow . Cerebral blood volume . Permeability surface area product . Hemorrhagic transformation . Primary hemorrhage
Introduction According to the World Health Organization, stroke is the world’s leading cause of long-term morbidity and the third leading cause of death in developed countries. Over the past two decades, there has been an overall reduction in strokerelated deaths in the USA—a 30 % decrease from 1995 to 2005; however, within certain racial groups and gender cohorts, stroke incidence and severity has worsened, while overall recurrence remains unchanged [1–5]. Advancement in acute stroke management may help decrease overall stroke burden. In general, stroke is caused by variable disturbances in blood flow to intracranial structures due to lack of blood supply (ischemia) or leakage of blood from vessels (hemorrhage). Accordingly, these cerebrovascular accidents have distinct etiologies: the former caused by thromboembolism or systemic hypoperfusion leading to local or global cerebral ischemia, respectively, and the latter caused by a rupture of weakened vascular walls within or ar
Data Loading...
