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stroke and CT perfusion

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https://www.readbyqxmd.com/read/29218615/advanced-ct-for-diagnosis-of-seizure-related-stroke-mimics
#1
Friederike Austein, Monika Huhndorf, Johannes Meyne, Helmut Laufs, Olav Jansen, Thomas Lindner
BACKGROUND AND PURPOSE: It is assumed that up to 30 % of clinically diagnosed acute ischaemic strokes (AIS) are actually stroke mimics (SM). Our aim was to evaluate the usefulness of advanced CT including CT angiography (CTA) and CT perfusion (CTP) findings when distinguishing AIS from seizure-related SM. METHODS: Over a 22-month period data were gathered of patients who presented to our stroke centre with AIS-like symptoms and were examined immediately with an advanced CT, analysed and evaluated by two experienced neuroradiologists who preferred SM rather than AIS...
December 7, 2017: European Radiology
https://www.readbyqxmd.com/read/29205466/ischemic-core-thresholds-change-with-time-to-reperfusion-a-case-control-study
#2
Andrew Bivard, Tim Kleinig, Ferdinand Miteff, Kenneth Butcher, Longting Lin, Christopher Levi, Mark Parsons
INTRODUCTION: We aimed to identify if acute ischemic stroke patients with known complete reperfusion after thrombectomy had the same baseline CTP ischemic core threshold to predict infarction as thrombolysis patients with complete reperfusion. METHODS: Patients who underwent thrombectomy were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to patients who were treated with intravenous alteplase alone from the International Stroke Perfusion Imaging Registry...
December 4, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/29190675/in-patients-with-suspected-acute-stroke-ct-perfusion-based-cerebral-blood-flow-maps-cannot-substitute-for-dwi-in-measuring-the-ischemic-core
#3
William A Copen, Albert J Yoo, Natalia S Rost, Lívia T Morais, Pamela W Schaefer, R Gilberto González, Ona Wu
BACKGROUND: Neuroimaging may guide acute stroke treatment by measuring the volume of brain tissue in the irreversibly injured "ischemic core." The most widely accepted core volume measurement technique is diffusion-weighted MRI (DWI). However, some claim that measuring regional cerebral blood flow (CBF) with CT perfusion imaging (CTP), and labeling tissue below some threshold as the core, provides equivalent estimates. We tested whether any threshold allows reliable substitution of CBF for DWI...
2017: PloS One
https://www.readbyqxmd.com/read/29182658/high-permeability-region-size-on-perfusion-ct-predicts-hemorrhagic-transformation-after-intravenous-thrombolysis-in-stroke
#4
Josep Puig, Gerard Blasco, Pepus Daunis-I-Estadella, Cecile van Eendendburg, María Carrillo-García, Carlos Aboud, María Hernández-Pérez, Joaquín Serena, Carles Biarnés, Kambiz Nael, David S Liebeskind, Götz Thomalla, Bijoy K Menon, Andrew Demchuk, Max Wintermark, Salvador Pedraza, Mar Castellanos
OBJECTIVE: Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke. METHODS: We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4...
2017: PloS One
https://www.readbyqxmd.com/read/29175568/borderline-aspect-score-patients-with-acute-ischaemic-stroke-due-to-large-vessel-occlusion-may-find-benefit-with-endovascular-thrombectomy
#5
Caitriona Logan, Julian Maingard, Kevin Phan, Ronan Motyer, Christen Barras, Seamus Looby, Paul Brennan, Alan O'Hare, Duncan Mark Brooks, Ronil V Chandra, Hamed Asadi, Hong Kuan Kok, John Thornton
OBJECTIVE: Selection of patients with acute ischaemic stroke (AIS) for endovascular thrombectomy (EVT) is complex and time-critical. The benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (ASPECTS ≤6), with a smaller infarct group (ASPECTS 7-10). METHODS: 355 patients with AIS due to large vessel occlusion (LVO) who underwent EVT were included...
November 22, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29172990/thresholds-for-infarction-vary-between-gray-matter-and-white-matter-in-acute-ischemic-stroke-a-ct-perfusion-study
#6
Chushuang Chen, Andrew Bivard, Longting Lin, Christopher R Levi, Neil J Spratt, Mark W Parsons
We aimed to investigate optimal perfusion thresholds defining ischemic core and penumbra for hemispheric-cortical gray matter (GM) and subcortical white matter (WM). A total of 65 sub-6 h ischemic stroke patients were assessed, who underwent acute computed tomography perfusion (CTP) and acute magnetic resonance imaging. CTP maps were generated by both standard singular value deconvolution (sSVD) and SVD with delay and dispersion correction (ddSVD). Analyses were undertaken to calculate sensitivity, specificity, and area under the curve (AUC) for each CTP threshold for core and penumbra in GM and WM...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29163351/computed-tomography-perfusion-alberta-stroke-program-early-computed-tomography-score-is-associated-with-hemorrhagic-transformation-after-acute-cardioembolic-stroke
#7
Lan Liu, Bo Wu, Jinglong Zhao, Yanyan Cao, Nikita Dedhia, Louis R Caplan, Qiaoshu Wang
Alberta Stroke Program Early Computed Tomography (CT) score (ASPECTS) has been applied to CT perfusion (CTP) with good interrater agreement to predict early ischemic stroke, and it can be useful in decision making in acute ischemic stroke. The aim of the present study was to assess the predictive value of CTP ASPECTS of hemorrhagic transformation (HT) in acute cardioembolic stroke. This is a single-enter, retrospective study. All patients hospitalized with acute cardioembolic stroke from January 2008 to September 2013 were included...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29160168/cerebral-blood-volume-lesion-extent-predicts-functional-outcome-in-patients-with-vertebral-and-basilar-artery-occlusion
#8
Fana Alemseged, Darshan G Shah, Andrew Bivard, Timothy J Kleinig, Nawaf Yassi, Marina Diomedi, Francesca Di Giuliano, Gagan Sharma, Roy Drew, Bernard Yan, Richard J Dowling, Steven Bush, Fabrizio Sallustio, Carlo Caltagirone, Nicola B Mercuri, Roberto Floris, Mark W Parsons, Christopher R Levi, Peter J Mitchell, Stephen M Davis, Bruce Cv Campbell
Background CT perfusion may improve diagnostic accuracy in posterior circulation stroke. The posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) on Computed Tomography Angiography source images (CTA-SI) predicts functional outcome in patients with basilar artery occlusion. Aims We assessed the prognostic value of pc-ASPECTS on CT perfusion in patients with vertebral and basilar artery occlusion (VBAO) in comparison with CTA-SI. Methods Whole-brain CT perfusion from consecutive stroke patients with VBAO at four stroke centers was retrospectively analyzed...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29135347/relative-cerebral-blood-volume-is-associated-with-collateral-status-and-infarct-growth-in-stroke-patients-in-swift-prime
#9
Juan F Arenillas, Elisa Cortijo, Pablo García-Bermejo, Elad I Levy, Reza Jahan, Mayank Goyal, Jeffrey L Saver, Gregory W Albers
We aimed to evaluate how predefined candidate cerebral perfusion parameters correlate with collateral circulation status and to assess their capacity to predict infarct growth in patients with acute ischemic stroke (AIS) eligible for endovascular therapy. Patients enrolled in the SWIFT PRIME trial with baseline computed tomography perfusion (CTP) scans were included. RAPID software was used to calculate mean relative cerebral blood volume (rCBV) in hypoperfused regions, and hypoperfusion index ratio (HIR). Blind assessments of collaterals were performed using CT angiography in the whole sample and cerebral angiogram in the endovascular group...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29120918/tissue-is-more-important-than-time-insights-into-acute-ischemic-stroke-from-modern-brain-imaging
#10
Andrew Bivard, Mark Parsons
PURPOSE OF REVIEW: The clinical practice of acute ischemic stroke treatment has undergone a major change over the last 5 years, as multimodal imaging becomes more accessible, and evidence mounts that individualized treatment is possible. Multimodal imaging performed before treatment provides invaluable information to treating clinicians, which includes confirmation of the diagnosis, and provides guidance on the appropriateness and the likely outcome of intravenous or endovascular treatment for individual patients (and their families)...
November 7, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29109882/successful-mechanical-thrombectomy-of-a-middle-cerebral-artery-occlusion-14-hours-after-stroke-onset
#11
Anelia Dietmann, Kety Wha-Vei Hsieh, Andrea M Humm, Claudio L Bassetti, Urs Fischer, Jan Gralla
A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29083523/mri-of-plaque-characteristics-and-relationship-with-downstream-perfusion-and-cerebral-infarction-in-patients-with-symptomatic-middle-cerebral-artery-stenosis
#12
Shan-Shan Lu, Song Ge, Chun-Qiu Su, Jun Xie, Jian Mao, Hai-Bin Shi, Xun-Ning Hong
BACKGROUND: Intracranial plaque characteristics are associated with stroke events. Differences in plaque features may explain the disconnect between stenosis severity and the presence of ischemic stroke. PURPOSE: To investigate the relationship between plaque characteristics and downstream perfusion changes, and their contribution to the occurrence of cerebral infarction beyond luminal stenosis. STUDY TYPE: Case control. SUBJECTS: Forty-six patients with symptomatic middle cerebral artery (MCA) stenosis (with acute cerebral infarction, n = 30; without acute cerebral infarction, n = 16)...
October 30, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/29056285/the-role-of-multimodal-imaging-in-stroke-code-patients
#13
M Grau García, M Pérez Bea, A López Medina
In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients...
October 19, 2017: Radiología
https://www.readbyqxmd.com/read/29054448/brain-ischemia-ct-and-mri-techniques-in-acute-ischemic-stroke
#14
REVIEW
Pedro Vilela, Howard A Rowley
Imaging plays a central role for intravenous and intra-arterial arterial ischemic stroke treatment patient selection. Computed tomography (CT) / CT angiography or magnetic resonance (MR) / MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify the arterial occlusion. Imaging may identify the patients that will be benefit more from revascularization therapies independently of the conventional therapeutic time window allowing individualized treatment decisions and improving individual patient outcome...
August 24, 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/29037436/which-imaging-before-reperfusion-strategy
#15
REVIEW
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29033392/mechanical-recanalization-in-ischemic-anterior-circulation-stroke-within-an-8-hour-time-window-a-real-world-experience
#16
Dagmar Krajíčková, Antonín Krajina, Roman Herzig, Miroslav Lojík, Vendelín Chovanec, Jan Raupach, Eva Vítková, Jan Waishaupt, Oldřich Vyšata, Martin Vališ
PURPOSE: We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6-8 h/unknown onset time, as only limited data are available for a time window beyond 6 h. METHODS: Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time...
November 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28994833/the-efficacy-and-safety-of-endovascular-recanalization-of-occluded-large-cerebral-arteries-during-the-subacute-phase-of-cerebral-infarction-a-case-series-report
#17
Kangning Chen, Xianhua Hou, Zhenhua Zhou, Guangjian Li, Qu Liu, Li Gui, Jun Hu, Shugui Shi
BACKGROUND: Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke. Due to the short treatment time window (<6 hours) and often treatment failure, these patients would still have an intracranial arterial occlusion (IAO). It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase. In this retrospective study, we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) for IAO in the subacute phase of their stroke...
September 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28987196/overview-of-neuroradiology
#18
Elna-Marie Larsson, Johan Wikström
Neuroradiology with computed tomography (CT) and magnetic resonance imaging (MRI) is essential for the initial evaluation of patients with a clinical suspicion of brain and spine disorders. Morphologic imaging is required to obtain a probable diagnosis to support the treatment decisions in pre- and perinatal disorders, vascular diseases, traumatic injuries, metabolic disorders, epilepsy, infection/inflammation, neurodegenerative disorders, degenerative spinal disease, and tumors of the central nervous system...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28976180/magnetic-particle-imaging-for-real-time-perfusion-imaging-in-acute-stroke
#19
Peter Ludewig, Nadine Gdaniec, Jan Sedlacik, Nils D Forkert, Patryk Szwargulski, Matthias Graeser, Gerhard Adam, Michael G Kaul, Kannan M Krishnan, R Matthew Ferguson, Amit P Khandhar, Piotr Walczak, Jens Fiehler, Götz Thomalla, Christian Gerloff, Tobias Knopp, Tim Magnus
The fast and accurate assessment of cerebral perfusion is fundamental for the diagnosis and successful treatment of stroke patients. Magnetic particle imaging (MPI) is a new radiation-free tomographic imaging method with a superior temporal resolution, compared to other conventional imaging methods. In addition, MPI scanners can be built as prehospital mobile devices, which require less complex infrastructure than computed tomography (CT) and magnetic resonance imaging (MRI). With these advantages, MPI could accelerate the stroke diagnosis and treatment, thereby improving outcomes...
October 24, 2017: ACS Nano
https://www.readbyqxmd.com/read/28971700/clinical-imaging-and-electroencephalographic-characterization-of-three-cases-of-handl-syndrome
#20
Sonia Quintas, Rocío López Ruiz, Santiago Trillo, Ana Beatriz Gago-Veiga, Gustavo Zapata-Wainberg, Julio Dotor García-Soto, Álvaro Ximénez-Carrillo, Jose Vivancos
Introduction The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) may mimic stroke when patients present with acute/subacute focal neurological deficits. It would be helpful to identify investigations that assist the neurologist in differentiating between HaNDL and stroke. Case reports We describe three cases that proved to be HaNDL, but were initially considered to be strokes. Hypoperfusion was noted in the CT perfusion (CTP) studies in all three cases, which extended beyond any single cerebral arterial supply...
January 1, 2017: Cephalalgia: An International Journal of Headache
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