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CT Perfusion acute ischemic stroke brain neuroimaging

Arturo Renú, Carlos Laredo, Raúl Tudela, Xabier Urra, Antonio Lopez-Rueda, Laura Llull, Laura Oleaga, Sergio Amaro, Ángel Chamorro
Endovascular reperfusion therapy is increasingly used for acute ischemic stroke treatment. The occurrence of parenchymal hemorrhage is clinically relevant and increases with reperfusion therapies. Herein we aimed to examine the optimal perfusion CT-derived parameters and the impact of the duration of brain ischemia for the prediction of parenchymal hemorrhage after endovascular therapy. A cohort of 146 consecutive patients with anterior circulation occlusions and treated with endovascular reperfusion therapy was analyzed...
December 7, 2015: Journal of Cerebral Blood Flow and Metabolism
Christopher D d'Esterre, Richard I Aviv, Laura Morrison, Enrico Fainardi, Ting Yim Lee
In a porcine ischemic stroke model, we sought to compare the acute predicted infarct core volume (PIV) defined by CT perfusion (CTP)-hemodynamic parameters and MR-diffusion-weighted imaging (MR-DWI)/apparent diffusion coefficient (ADC), with the true infarct core volume (TIV) as defined by histology. Ten Duroc-cross pigs had a CTP scan prior to injection of endothelin-1 (ET-1) into the left striatum. CTP scans were used to monitor ischemic progression. A second dose of ET-1 was injected 2 h from the first injection...
June 2015: Translational Stroke Research
Haitham Dababneh, Asif Bashir, Waldo R Guerrero, Kelvin Wilson, Mohammed Hussain, Sara Misthal, Walter Morgan, Keith Peters, Jawad F Kirmani, J Mocco
BACKGROUND: Neuroimaging techniques have been beneficial in identifying patients with salvageable penumbra. We sought to validate the mean transit time (MTT) map on computed tomography perfusion (CTP) imaging utilizing an Aquilion ONE computed tomography (CT) scanner running a singular value decomposition plus algorithm in patients with acute large vessel ischemic stroke who underwent endovascular therapy. METHODS: We conducted a retrospective analysis of consecutive patients presenting to the emergency room who met the following criteria: 1) had a large vessel acute ischemic stroke; 2) had a high-quality whole-brain CTP; 3) treated with endovascular therapy; and 4) received a follow-up MRI with diffusion-weighted imaging (DWI) within 48 h...
December 2014: Journal of Vascular and Interventional Neurology
Dora K Zlatareva, Nikoleta I Traykova
The aim of this review was to present the modern concepts of diagnostic imaging in acute stroke. Neuroimaging in acute stroke aims at diagnosing the condition as early as possible and assessing the extent of parenchymal perfusion and the intracranial vessels patency. A modern approach would involve a combination of various imaging modalities as multidetector computed tomography and high field magnetic resonance imaging. A non-enhanced computed tomography (CT) is used to detect hemorrhage or to identify early signs of ischemic stroke...
April 2014: Folia Medica
M N Islam, R Kuddus, N S Chowdhury, M D Akhter, G Salahuddin, S Parvin
Imaging cerebral infarction in first few hours after the onset of clinical symptoms is a challenge. The role of stroke imaging underwent a paradigm shift from confirmation of infarction from and exclusion of hemorrhage to the detection of the tissue at risk that may be rescued with restoration of circulation. Computed tomography (CT) is generally performed before starting the therapy in order to exclude the presence of bleeding and tumors. Although CT may show findings of infarction as early as 3-6 hours after ictus 30% of CT scans are normal in the first few hours after ischemic insult...
July 2014: Mymensingh Medical Journal: MMJ
Nazli Janjua
Revascularization time windows for patients with acute ischemic stroke are generally restricted to 8 hours. Later treatment attempts require more accurate prediction of risk and benefit, as safety and efficacy at these time strata are less well demonstrated. Advanced imaging techniques identify irreversible infarction as well as tissue at risk. Diffusion-weighted MRI detects ischemia within minutes of onset, whereas perfusion-weighted MRI and CT perfusion studies disclose the ischemic penumbra. Combined, they provide information on mismatched tissue-potentially salvageable brain...
September 25, 2012: Neurology
Gurpreet Singh Sandhu, Jeffrey L Sunshine
Traditionally non-contrast CT has been considered the first choice imaging modality for acute stroke. Acute ischemic stroke patients presenting to the hospital within 3-hours from symptom onset and without any visible hemorrhages or large lesions on CT images are considered optimum reperfusion therapy candidates. However, non-contrast CT alone has been unable to identify best reperfusion therapy candidates outside this window. New advanced imaging techniques are now being used successfully for this purpose...
December 2012: Current Cardiology Reports
Lauren M Nentwich, William Veloz
This article reviews the various imaging modalities available for the evaluation of patients presenting with a potential stroke syndrome, specifically acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. It reviews the various computed tomography (CT) modalities, including noncontrast brain CT (NCCT), CT angiography, and CT perfusion. It discusses multimodal magnetic resonance imaging in the evaluation of patients with acute stroke, including diffusion-weighted imaging, T2-weighted sequences/fluid-attenuated inversion recovery, magnetic resonance angiography, perfusion-weighted imaging, and gradient-recalled echo...
August 2012: Emergency Medicine Clinics of North America
Andrew Mark Allmendinger, Elizabeth R Tang, Yvonne W Lui, Vadim Spektor
OBJECTIVE: Perfusion CT is being increasingly used as a diagnostic tool for the evaluation of acute ischemic stroke. It can be performed rapidly and aids in the detection of salvageable tissue (penumbra) from the unsalvageable core infarct. The purpose of this article is to provide an overview of the imaging technique, interpretation pearls, and common pitfalls encountered in perfusion CT of the brain. CONCLUSION: Perfusion CT has proven to be a valuable tool in the diagnosis of acute ischemic stroke...
January 2012: AJR. American Journal of Roentgenology
Albert J Yoo, Benjamin Pulli, R Gilberto Gonzalez
Reperfusion therapy is the only approved treatment for acute ischemic stroke. The current approach to patient selection is primarily based on the time from stroke symptom onset. However, this algorithm sharply restricts the eligible patient population, and neglects large variations in collateral circulation that ultimately determine the therapeutic time window in individual patients. Time alone is unlikely to remain the dominant parameter. Alternative approaches to patient selection involve advanced neuroimaging methods including MRI diffusion-weighted imaging, magnetic resonance and computed tomography perfusion imaging and noninvasive angiography that provide potentially valuable information regarding the state of the brain parenchyma and the neurovasculature...
July 2011: Expert Review of Cardiovascular Therapy
Tudor G Jovin, David S Liebeskind, Rishi Gupta, Marilyn Rymer, Ansaar Rai, Osama O Zaidat, Alex Abou-Chebl, Blaise Baxter, Elad I Levy, Andrew Barreto, Raul G Nogueira
BACKGROUND AND PURPOSE: Current selection criteria for intra-arterial therapies in the anterior circulation use time windows of 8 hours. Modern neuroimaging techniques have identified individuals with salvageable penumbra who present beyond this timeframe. We sought to assess safety, procedural, and clinical outcomes of MRI or CT perfusion imaging-based endovascular therapy in patients with anterior circulation stroke treated beyond 8 hours from time last seen well. METHODS: We conducted a multicenter retrospective review of consecutive patients meeting the following criteria: (1) acute proximal intracranial anterior circulation occlusion; (2) endovascular treatment initiated >8 hours from time last seen well; and (3) treatment selection based on MRI or CT perfusion imaging...
August 2011: Stroke; a Journal of Cerebral Circulation
Carlos Leiva-Salinas, Max Wintermark, Chelsea S Kidwell
The imaging workup for patients with suspected acute ischemic stroke has advanced significantly over the past few years. Evaluation is no longer limited to noncontrast computed tomography, but now frequently also includes vascular and perfusion imaging. Although acute stroke imaging has made significant progress in the last few decades with the development of multimodal approaches, there are still many unanswered questions regarding their appropriate use in the setting of daily patient care. It is important for all physicians taking care of stroke patients to be familiar with current multimodal computed tomography and magnetic resonance imaging techniques, including their strengths, limitations, and their role in guiding therapy...
January 2011: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Zai-Qiang Zhang, Song-Tao Niu, Xian-Hong Liang, Fan Jian, Yongjun Wang
OBJECTIVE: The aim of this study was to perform perfusion CT imaging in the acute phase of myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), to assess whether these patients had cerebral perfusion abnormalities. Furthermore, the pathology of muscle vessel was evaluated, to explore the role of vasculopathy and ischemic events in the pathogenesis of mitochondrial encephalomyopathies. METHODS: Computed tomography perfusion (CTP) imaging was applied to the evaluation of brain perfusion during the symptomatic period of mitochondrial encephalomyopathies...
May 2010: Neurological Research
Gisele S Silva, Fabricio O Lima, Erica C S Camargo, Wade S Smith, Aneesh B Singhal, David M Greer, Hakan Ay, Michael H Lev, Gordon J Harris, Elkan F Halpern, Shruti Sonni, Walter Koroshetz, Karen L Furie
BACKGROUND: Approximately 25% of ischemic stroke patients awaken with neurological deficits. In these patients, in whom the time from symptom onset is uncertain, brain imaging is a potential strategy to characterize the ischemia duration and the presence of salvageable brain tissue. METHODS: We prospectively evaluated consecutive patients with acute ischemic stroke. CT angiography and CT perfusion (CTP) were performed in patients within 24 h of symptom onset. The patients were classified into 'known onset', 'indefinite onset but not on awakening' and 'wake-up stroke' groups...
2010: Cerebrovascular Diseases
Monica Saini, Ken Butcher
Neuroimaging is fundamental to stroke diagnosis and management. Non-contrast computed tomography (NCCT) has been the primary imaging modality utilized for this purpose for almost four decades. Although NCCT does permit identification of intracranial hemorrhage and parenchymal ischemic changes, insights into blood vessel patency and cerebral perfusion are limited. Advances in reperfusion strategies have made identification of potentially salvageable brain tissue a more practical concern. Advances in CT technology now permit identification of acute and chronic arterial lesions, as well as cerebral blood flow deficits...
September 2009: Neurology India
Chelsea S Kidwell, Amie W Hsia
Although neuroimaging remains the foundation for the diagnosis of cerebrovascular disease, ongoing technologic advances have now opened up new frontiers for stroke evaluation and treatment. Neuroimaging studies can provide crucial information regarding tissue injury (size, location, and degree of reversibility of ischemic injury as well as presence of hemorrhage), vessel status (site and severity of stenoses and occlusions), and cerebral perfusion (size, location, and severity of hypoperfusion). This information can be combined to identify patients with salvageable penumbral tissue who may benefit most from acute therapies...
January 2006: Current Neurology and Neuroscience Reports
Erica C Sá de Camargo, Walter J Koroshetz
Since the introduction of thrombolytic therapy as the foundation of acute stroke treatment, neuroimaging has rapidly advanced to empower therapeutic decision making. Diffusion-weighted imaging is the most sensitive and accurate method for stroke detection, and, allied with perfusion-weighted imaging, provides information on the functional status of the ischemic brain. It can also help to identify a response to thrombolytic and neuroprotective therapies. Additionally, multimodal magnetic resonance imaging, including magnetic resonance angiography, offers information on stroke mechanism and pathophysiology that can guide long-term medical management...
April 2005: NeuroRx: the Journal of the American Society for Experimental NeuroTherapeutics
Lucas Restrepo, Michael A Jacobs, Peter B Barker, Robert J Wityk
BACKGROUND: Diagnosing TIA can be difficult, since evidence of brain ischemia is habitually lacking on CT and conventional MR imaging. It has been suggested that patients with acute brain infarction on neuroimaging should be considered stroke cases instead of TIA, regardless of duration of symptoms, implying that optimal diagnostic methods need to be utilized. We therefore postulated that perfusion-weighted MR imaging (PW imaging) would be useful in the diagnosis of TIA. METHODS: Retrospective analysis of 22 patients with reversible neurologic symptoms lasting less than 24 hours, assessed with DW and PW imaging...
November 2004: AJNR. American Journal of Neuroradiology
H A Desal, E Auffray-Calvier, B Guillon, F Toulgoat, A Madoz, A De Kersaint-Gilly, A Pasco-Papon
Over the last 25 years, advances in neuroimaging have significantly changed the evaluation and management of acute stroke syndromes. In the seventies, computed tomography (CT) could differentiate between ischemic and hemorrhagic stroke. Magnetic resonance imaging (MRI) is nowadays the imaging modality of choice in the initial assessment of acute stroke. MRI images can better discriminate acute, subacute and chronic infarcts, differentiate venous from arterial infarcts, detect arterial dissection, stenosis or occlusion...
September 2004: Journal of Neuroradiology. Journal de Neuroradiologie
William J Powers, Allyson R Zazulia
Even with rapid development of other neuroimaging modalities such as MR imaging and CT, PET is the only technique that provides accurate, quantitative measurements of regional hemodynamics and metabolism in human subjects. Through the use of these combined measurements, we have greatly expanded our knowledge of the pathophysiology of cerebrovascular disease of different types. It has been possible to document the compensatory responses of the brain to reductions in perfusion pressure and to directly relate these responses to prognosis...
November 2003: Neuroimaging Clinics of North America
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