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stroke and CT perfusion

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https://www.readbyqxmd.com/read/27917312/a-4d-ct-digital-phantom-of-an-individual-human-brain-for-perfusion-analysis
#1
Rashindra Manniesing, Christoph Brune, Bram van Ginneken, Mathias Prokop
Brain perfusion is of key importance to assess brain function. Modern CT scanners can acquire perfusion maps of the cerebral parenchyma in vivo at submillimeter resolution. These perfusion maps give insights into the hemodynamics of the cerebral parenchyma and are critical for example for treatment decisions in acute stroke. However, the relations between acquisition parameters, tissue attenuation curves, and perfusion values are still poorly understood and cannot be unraveled by studies involving humans because of ethical concerns...
2016: PeerJ
https://www.readbyqxmd.com/read/27891826/ct-brain-perfusion-a-static-phantom-study-of-contrast-to-noise-ratio-and-radiation-dose
#2
Stewart M Midgley, Damien L Stella, Bruce Cv Campbell, Francesca Langenberg, Paul F Einsiedel
INTRODUCTION: Computed tomography perfusion (CTP) is increasingly employed in the diagnosis and management of ischaemic stroke but radiation dose can be significant and optimising contrast-to-noise ratio (CNR) is challenging. This study aimed to quantify and optimise the balance between CNR as a surrogate for image quality and radiation dose. METHODS: A perspex head phantom with vials of dilute contrast agent was scanned using a Siemens Definition Flash 128-slice scanner...
November 27, 2016: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/27886985/efficacy-of-lens-protection-systems-dependency-on-different-cranial-ct-scans-in-the-acute-stroke-setting
#3
Nika Guberina, Michael Forsting, Adrian Ringelstein
To evaluate the dose-reduction potential with different lens protectors for patients undergoing cranial computed tomography (CT) scans. Eye lens dose was assessed in vitro (α-Al2O3:C thermoluminescence dosemeters) using an Alderson-Rando phantom(®) in cranial CT protocols at different CT scanners (SOMATOM-Definition-AS+(®)(CT1) and SOMATOM-Definition-Flash(®) (CT2)) using two different lens-protection systems (Somatex(®) (SOM) and Medical Imaging Systems(®) (MIS)). Summarised percentage of the transmitted photons: (1) CT1 (a) unenhanced CT (nCT) with gantry angulation: SOM = 103%, MIS = 111%; (2) CT2 (a) nCT without gantry angulation: SOM = 81%, MIS = 91%; (b) CT angiography (CTA) with automatic dose-modulation technique: SOM = 39%, MIS = 74%; (c) CTA without dose-modulation technique: SOM = 22%, MIS = 48%; (d) CT perfusion: SOM = 44%, MIS = 69%...
November 24, 2016: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/27879445/agreement-among-stroke-faculty-and-fellows-in-treating-ischemic-stroke-patients-with-tissue-type-plasminogen-activator-and-thrombectomy
#4
Ahmad-Riad Ramadan, Mary Carter Denny, Farhaan Vahidy, Jose-Miguel Yamal, Tzu-Ching Wu, Amrou Sarraj, Sean Savitz, James Grotta
BACKGROUND AND PURPOSE: The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT). METHODS: Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients. RESULTS: In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0...
November 22, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27807278/number-needed-to-screen-for-acute-revascularization-trials-in-stroke-prognostic-and-predictive-imaging-biomarkers
#5
Qinghua Hou, James L Patrie, Wenjun Xin, Patrik Michel, Tudor Jovin, Ashraf Eskandari, Max Wintermark
OBJECTIVE: To systematically assess imaging biomarkers on CT-based multimodal imaging for their being predictive versus prognostic biomarkers for intravenous and endovascular (IA) revascularization therapy, and for their prevalence. METHODS: Our retrospective study included patients suspected of acute ischemic stroke with admission work-up including a non-contrast head CT, perfusion CT, and CT angiography. Modified Rankin scores at 90 days were used as outcomes...
November 2, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27807197/venous-imaging-based-biomarkers-in-acute-ischaemic-stroke
#6
REVIEW
Josep Munuera, Gerard Blasco, María Hernández-Pérez, Pepus Daunis-I-Estadella, Antoni Dávalos, David S Liebeskind, Max Wintermark, Andrew Demchuk, Bijoy K Menon, Götz Thomalla, Kambiz Nael, Salvador Pedraza, Josep Puig
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography...
November 2, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27806106/voxel-based-sensitivity-of-flat-panel-ct-for-the-detection-of-intracranial-hemorrhage-comparison-to-multi-detector-ct
#7
Andreas M Frölich, Jan-Hendrik Buhk, Jens Fiehler, Andre Kemmling
OBJECTIVES: Flat-panel CT (FPCT) allows cross-sectional parenchymal, vascular and perfusion imaging within the angiography suite, which could greatly facilitate acute stroke management. We hypothesized that FPCT offers equal diagnostic accuracy compared to multi-detector CT (MDCT) as a primary tool to exclude intracranial hemorrhage. METHODS: 22 patients with intracranial hematomas who had both MDCT and FPCT performed within 24 hours were retrospectively identified...
2016: PloS One
https://www.readbyqxmd.com/read/27801538/added-value-of-multimodal-computed-tomography-imaging-analysis-of-1994-acute-ischaemic-strokes
#8
O Bill, M Faouzi, R Meuli, P Maeder, M Wintermark, P Michel
BACKGROUND AND PURPOSE: Multimodal computed tomography (CT) based imaging (MCTI) is widely used in acute ischaemic stroke. It was postulated that the use of MCTI is associated with improved patient outcome without causing harm. METHODS: All patients with an acute ischaemic stroke and CT-based imaging within 24 h from the ASTRAL (Acute Stroke Registry and Analysis of Lausanne) registry were included. Preceding demographic, clinical, biological, radiological and follow-up data were collected...
November 1, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/27789149/noncontrast-computed-tomography-versus-computed-tomography-angiography-source-images-for-predicting-final-infarct-size-in-anterior-circulation-acute-ischemic-stroke-a-prospective-cohort-study
#9
Amritendu Mukherjee, Prakash Muthusami, Aneesh Mohimen, Srinivasan K, Babunath B, Sylaja Pn, Chandrasekharan Kesavadas
BACKGROUND: There has been a recent debate regarding the superiority of computed tomography angiography source images (CTASIs) over noncontrast computed tomography (NCCT) to predict the final infarct size in acute ischemic stroke (AIS). We hypothesized that the parenchymal abnormality on CTASI in faster scanners would overestimate ischemic core. METHODS: This prospective study assessed the correlation of Alberta Stroke Program Early CT Score (ASPECTS) on NCCT, CTASI, and computed tomography perfusion (CTP) with final infarct size in patients within 8 hours of AIS...
October 24, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27781042/cbv_aspects-improvement-over-ct_aspects-on-determining-irreversible-ischemic-lesion-decreases-over-time
#10
Marina Padroni, Sandra Boned, Marc Ribó, Marian Muchada, David Rodriguez-Luna, Pilar Coscojuela, Alejandro Tomasello, Jordi Cabero, Jorge Pagola, Noelia Rodriguez-Villatoro, Jesus M Juega, Estela Sanjuan, Carlos A Molina, Marta Rubiera
: The Alberta Stroke Program Early CT Score (ASPECTS) is a useful scoring system for assessing early ischemic signs on noncontrast computed tomography (CT). Cerebral blood volume (CBV) on CT perfusion defines the core lesion assumed to be irreversibly damaged. We aim to explore the advantages of CBV_ASPECTS over CT_ASPECTS in the prediction of final infarct volume according to time. METHODS: Consecutive patients with anterior circulation stroke who underwent endovascular reperfusion according to initial CT_ASPECTS ≥7 were studied...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27771707/peripheral-immune-cell-counts-and-advanced-imaging-as-biomarkers-of-stroke-outcome
#11
Heather Pagram, Andrew Bivard, Lisa F Lincz, Christopher Levi
INTRODUCTION: Circulating neutrophil and lymphocyte levels may be modifiable outcome predictors of ischemic stroke. We sought to compare these immune cell parameters with advanced imaging assessment and the 90-day clinical outcome. METHODS: We used a retrospectively collected cohort of consecutive ischemic stroke patients presenting within 4.5 h of symptom onset who had acute CT perfusion and routine blood collection before treatment with intravenous thrombolysis and 24-hour MRI scanning at the John Hunter Hospital...
January 22, 2016: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/27758774/body-temperature-modulates-infarction-growth-following-endovascular-reperfusion
#12
S Dehkharghani, M Bowen, D C Haussen, T Gleason, A Prater, Q Cai, J Kang, R G Nogueira
BACKGROUND AND PURPOSE: The neuronal substrate is highly sensitive to temperature elevation; however, its impact on the fate of the ischemic penumbra has not been established. We analyzed interactions between temperature and penumbral expansion among successfully reperfused patients with acute ischemic stroke, hypothesizing infarction growth and worse outcomes among patients with fever who achieve full reperfusion. MATERIALS AND METHODS: Data from 129 successfully reperfused (modified TICI 2b/3) patients (mean age, 65 ± 15 years) presenting within 12 hours of onset were examined from a prospectively collected acute ischemic stroke registry...
October 6, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27753982/sy-08-2-hypertension-management-for-secondary-prevention-of-stroke
#13
Kazuyuki Shimada
Stroke is known to frequently recur in patients with a history of cerebrovascular disease, and the control of hypertension is extremely important for the treatment of those patients. The robust relationship between the recurrent cerebrovascular disease and blood pressure control has been demonstrated in large-scale clinical studies. The antihypertensive drug therapy significantly reduces the recurrence rate of all types of cerebrovascular disease, incidences of myocardial infarction and all vascular events...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27722798/detection-of-single-phase-cta-occult-vessel-occlusions-in-acute-ischemic-stroke-using-ct-perfusion-based-wavelet-transformed-angiography
#14
Wolfgang G Kunz, Wieland H Sommer, Lukas Havla, Franziska Dorn, Felix G Meinel, Olaf Dietrich, Grete Buchholz, Birgit Ertl-Wagner, Kolja M Thierfelder
OBJECTIVES: To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion. METHODS: Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction...
October 8, 2016: European Radiology
https://www.readbyqxmd.com/read/27718078/interleaving-cerebral-ct-perfusion-with-neck-ct-angiography-part-i-proof-of-concept-and-accuracy-of-cerebral-perfusion-values
#15
Marcel T H Oei, Frederick J A Meijer, Willem-Jan van der Woude, Ewoud J Smit, Bram van Ginneken, Mathias Prokop, Rashindra Manniesing
OBJECTIVES: We present a novel One-Step-Stroke protocol for wide-detector CT scanners that interleaves cerebral CTP with volumetric neck CTA (vCTA). We evaluate whether the resulting time gap in CTP affects the accuracy of CTP values. METHODS: Cerebral CTP maps were retrospectively obtained from 20 patients with suspicion of acute ischemic stroke and served as the reference standard. To simulate a 4 s gap for interleaving CTP with vCTA, we eliminated one acquisition at various time points of CTP starting from the bolus-arrival-time(BAT)...
October 7, 2016: European Radiology
https://www.readbyqxmd.com/read/27651328/diagnostic-accuracy-of-whole-brain-ct-perfusion-in-the-detection-of-acute-infratentorial-infarctions
#16
Christine Bollwein, Annika Plate, Wieland H Sommer, Kolja M Thierfelder, Hendrik Janssen, Maximilian F Reiser, Andreas Straube, Louisa von Baumgarten
INTRODUCTION: Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate. METHODS: Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes...
November 2016: Neuroradiology
https://www.readbyqxmd.com/read/27651144/interleaving-cerebral-ct-perfusion-with-neck-ct-angiography-part-ii-clinical-implementation-and-image-quality
#17
Marcel T H Oei, Frederick J A Meijer, Willem-Jan van der Woude, Ewoud J Smit, Bram van Ginneken, Rashindra Manniesing, Mathias Prokop
OBJECTIVES: Feasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA. METHODS: Twenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol...
September 21, 2016: European Radiology
https://www.readbyqxmd.com/read/27642893/sy-08-2-hypertension-management-for-secondary-prevention-of-stroke
#18
Kazuyuki Shimada
Stroke is known to frequently recur in patients with a history of cerebrovascular disease, and the control of hypertension is extremely important for the treatment of those patients. The robust relationship between the recurrent cerebrovascular disease and blood pressure control has been demonstrated in large-scale clinical studies. The antihypertensive drug therapy significantly reduces the recurrence rate of all types of cerebrovascular disease, incidences of myocardial infarction and all vascular events...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27637159/expanding-the-concept-of-neuroprotection-for-acute-ischemic-stroke-the-pivotal-roles-of-reperfusion-and-the-collateral-circulation
#19
REVIEW
Myron D Ginsberg
This review surveys the efforts taken to achieve clinically efficacious protection of the ischemic brain and underscores the necessity of expanding our purview to include the essential role of cerebral perfusion and the collateral circulation. We consider the development of quantitative strategies to measure cerebral perfusion at the regional and local levels and the application of these methods to elucidate flow-related thresholds of ischemic viability and to characterize the ischemic penumbra. We stress that the modern concept of neuroprotection must consider perfusion, the necessary substrate upon which ischemic brain survival depends...
October 2016: Progress in Neurobiology
https://www.readbyqxmd.com/read/27625381/aspects-alberta-stroke-program-early-ct-score-assessment-of-the-perfusion-diffusion-mismatch
#20
Louis Lassalle, Guillaume Turc, Marie Tisserand, Sylvain Charron, Pauline Roca, Stephanie Lion, Laurence Legrand, Myriam Edjlali, Olivier Naggara, Jean-François Meder, Jean-Louis Mas, Jean-Claude Baron, Catherine Oppenheim
BACKGROUND AND PURPOSE: Rapid and reliable assessment of the perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch is required to promote its wider application in both acute stroke clinical routine and trials. We tested whether an evaluation based on the Alberta Stroke Program Early CT Score (ASPECTS) reliably identifies the PWI/DWI mismatch. METHODS: A total of 232 consecutive patients with acute middle cerebral artery stroke who underwent pretreatment magnetic resonance imaging (PWI and DWI) were retrospectively evaluated...
October 2016: Stroke; a Journal of Cerebral Circulation
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