, Volume 56, Issue 12, pp 1121–1126 | Cite as

Whole brain CT perfusion in acute anterior circulation ischemia: coverage size matters

  • B. J. Emmer
  • M. Rijkee
  • J. M. Niesten
  • M. J. H. Wermer
  • B. K. Velthuis
  • M. A. A. van Walderveen
Functional Neuroradiology



Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice.


In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level.


Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10 % as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4 % for the 8-cm, 7 % for the 4-cm, and 13 % for the 3-cm coverage size.


This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage.


CT perfusion Whole brain Infarct core Stroke 


Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Medical Ethical Committee of the Leiden University Medical Centre and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • B. J. Emmer
    • 1
  • M. Rijkee
    • 2
  • J. M. Niesten
    • 4
  • M. J. H. Wermer
    • 3
  • B. K. Velthuis
    • 4
  • M. A. A. van Walderveen
    • 2
  1. 1.Department of RadiologyErasmus Medical CentreRotterdamThe Netherlands
  2. 2.Department of RadiologyLeiden University Medical CentreLeidenThe Netherlands
  3. 3.Department of NeurologyLeiden University Medical CentreLeidenThe Netherlands
  4. 4.Department of RadiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands

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