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stroke and CT perfusion

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https://www.readbyqxmd.com/read/29449280/prediction-of-the-multisegment-clot-sign-on-dynamic-ct-angiography-of-cardioembolic-stroke
#1
Z Chen, F Shi, M Zhang, X Gong, L Lin, M Lou
BACKGROUND AND PURPOSE: The multisegment clot sign has been observed at the site of large-artery occlusion in patients with acute ischemic stroke. This study aimed to assess its occurrence rate and relationship with stroke etiologies in patients with acute intracranial large-artery occlusion. MATERIALS AND METHODS: We included consecutive patients with acute ischemic stroke who had acute intracranial large-artery occlusion and underwent perfusion CT within 8 hours after stroke onset...
February 15, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29414151/migrainous-aura-as-stroke-mimic-the-role-of-perfusion-computed-tomography
#2
Mariana Ridolfi, Antonio Granato, Paola Polverino, Giovanni Furlanis, Maja Ukmar, Irene Zorzenon, Paolo Manganotti
OBJECTIVES: The acute-onset of migrainuos aura (MA) can be erroneously diagnosed in Emergency Department (ED) as acute stroke (AS) and it can be classified as "stroke mimic" (SM). Perfusion computer tomography (PCT) may be useful to improve detection of infarcts. The aim of the study was to investigate the role in ED of PCT in improving diagnosis of migrainous aura. Data were compared with the well-defined perfusion patterns in patients with acute ischemic stroke. PATIENTS AND METHODS: A standardized Stroke Protocol was planned...
January 31, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29402765/computed-tomography-perfusion-derived-blood-brain-barrier-permeability-does-not-yet-improve-prediction-of-hemorrhagic-transformation
#3
Alexander D Horsch, Edwin Bennink, Tom van Seeters, L Jaap Kappelle, Yolanda van der Graaf, Willem P T M Mali, Hugo W A M de Jong, Birgitta K Velthuis, Jan Willem Dankbaar
INTRODUCTION: Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT. MATERIALS AND METHODS: From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging...
January 8, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29402060/penumbral-imaging-based-thrombolysis-with-tenecteplase-is-feasible-up-to-24-hours-after-symptom-onset
#4
Mahesh Kate, Robert Wannamaker, Harsha Kamble, Parnian Riaz, Laura C Gioia, Brian Buck, Thomas Jeerakathil, Penelope Smyth, Ashfaq Shuaib, Kenneth Butcher, Derek Emery
BACKGROUND AND PURPOSE: Thrombolysis >4.5 hours after ischemic stroke onset is unproven. We assessed the feasibility of tenecteplase (TNK) treatment in patients with evidence of an ischemic penumbra 4.5 to 24 hours after onset. METHODS: Acute ischemic stroke patients underwent perfusion computed tomography (CT)/magnetic resonance imaging. Patients with cerebral blood volume (CBV) or diffusion weighted imaging Alberta Stroke Program Early CT Scores (ASPECTS) >6 and mismatch score >2 (defined as >2 ASPECTS regions with delay on mean transit time maps and normal CBV) were eligible for treatment with TNK (0...
January 2018: Journal of Stroke
https://www.readbyqxmd.com/read/29364529/time-separation-technique-accurate-solution-for-4-d-c-arm-ct-perfusion-imaging-using-a-temporal-decomposition-model
#5
Sebastian Bannasch, Robert Frysch, Tim Pfeiffer, Gerald Warnecke, Georg Rose
PURPOSE: The issue of perfusion imaging using a temporal decomposition model is to enable the reconstruction of undersampled measurements acquired with a slowly rotating X-ray-based imaging system e. g. a C-arm-based cone beam computed tomography (CB-CT). Aim of this work is to integrate prior knowledge into the dynamic CT task in order to reduce the required number of views and the computational effort as well as to save dose. The prior knowledge comprises of a mathematical model and clinical perfusion data...
January 24, 2018: Medical Physics
https://www.readbyqxmd.com/read/29351787/scl20a2-mutation-presenting-with-acute-ischemic-stroke-a-case-report
#6
Xiaoyu Zhang, Gaoting Ma, Zhangning Zhao, Meijia Zhu
BACKGROUND: Primary familial brain calcification (PFBC) is a rare disorder characterized by distinctive bilateral brain calcification and variable clinical presentations. However, cerebrovascular attack was rarely reported in PFBC patients. We here reported a SLC20A2 mutation patient presenting with acute ischemic stroke. CASE PRESENTATION: A 56 years old man was transferred to our hospital because of 6 days of melena and 3 days of somnolence, agitation and mood changes...
January 19, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29350878/perfusion-ct-in-posterior-circulation-stroke-predictors-and-prognostic-implications-of-focal-hypoperfusion
#7
Lars-Peder Pallesen, Dimitris Lambrou, Ashraf Eskandari, Jessica Barlinn, Kristian Barlinn, Heinz Reichmann, Vincent Dunet, Philippe Maeder, Volker Puetz, Patrik Michel
BACKGROUND: We aimed to determine predictors of focal hypoperfusion on CT Perfusion (CTP) in patients with acute posterior circulation stroke and its association with long-term outcome. METHODS: We selected patients with posterior circulation stroke from the Acute STroke Registry and Analysis of Lausanne (ASTRAL) who underwent CTP within 24 hours of stroke onset as part of the stroke imaging protocol. Hypoperfusion was defined as an area of visually well demarcated mean-transit-time (MTT) prolongation corresponding to an arterial territory on standard reconstruction CTP imaging maps...
January 19, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29282332/collateral-response-modulates-the-time-penumbra-relationship-in-proximal-arterial-occlusions
#8
Smriti Agarwal, Andrew Bivard, Elizabeth Warburton, Mark Parsons, Christopher Levi
OBJECTIVE: While clinical benefit from thrombolysis decreases with increase in time from stroke onset, the relationship of acute physiologic tissue compartments and collateral response to stroke onset time remains unclear. METHODS: We studied consecutive patients with proximal arterial occlusions (n = 355) with whole-brain perfusion CT with CT angiography within 6 hours of stroke onset. Penumbra and core were defined using voxel-based thresholds. Tissue mismatch was defined as the ratio of penumbra to core...
January 23, 2018: Neurology
https://www.readbyqxmd.com/read/29273536/variability-of-stroke-patients-meeting-endovascular-stroke-trial-criteria-in-a-non-clinical-trial-setting
#9
Jennifer E Fugate, Waleed Brinjikji, Harry Cloft, David F Kallmes, Alejandro A Rabinstein
BACKGROUND: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. METHODS: Retrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010-November 2014...
December 19, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/29259124/referral-facility-ct-perfusion-prior-to-inter-facility-transfer-in-patients-undergoing-mechanical-thrombectomy
#10
Amin Aghaebrahim, Eric Sauvageau, Pedro Aguilar-Salinas, Gustavo Cortez, Roberta Santos, Ricardo A Hanel
BACKGROUND AND PURPOSE: The use of CT perfusion (CTP) imaging at a referring hospital is feasible and may shorten the door to puncture time for patients with acute ischemic stroke. METHODS: We conducted a single center retrospective review of a prospectively maintained database of consecutive ischemic stroke patients transferred to our center for consideration of endovascular therapy. Patients were divided into two groups. Group 1 consisted of patients transferred from facilities where CTP (using automated RAPID software) was routinely performed and group 2 consisted of patients transferred from facilities that did not perform perfusion imaging...
December 19, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29218615/advanced-ct-for-diagnosis-of-seizure-related-stroke-mimics
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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)...
February 2018: Current Opinion in Neurology
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