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Emergency Radiology

, Volume 26, Issue 3, pp 319–329 | Cite as

An acute stroke CT imaging algorithm incorporating automated perfusion analysis

  • Danielle ByrneEmail author
  • John P. Walsh
  • Peter J. MacMahon
Review Article

Abstract

In this paper, we propose a CT imaging algorithm for patients presenting with suspected acute stroke that incorporates automated CT perfusion (CTP) imaging. The algorithm details evaluation of the non-contrast CT (NCCT) for hemorrhage and acute ischemia, calculation of ASPECTS, with performance and interpretation of CTP if appropriate. In particular, we consider the key steps in expeditious interpretation of non-contrast CT and CT angiography in the context of suspected acute ischemic stroke. Given the recent expansion of the “imaging based” treatment window for thrombectomy from 6 to 24 h in the 2018 American Heart Association stroke guidelines, we consider the key criteria in the decision to perform CT perfusion and the patient cohorts in which this might be most helpful. We also describe how imaging findings might be incorporated into the treatment paradigm for suspected with acute ischemic stroke and we allude to some of the most frequently encountered pitfalls associated with CTP which we think will be particularly helpful for radiologists and stroke physicians who are considering adding CT perfusion to their work-up for acute stroke.

Keywords

Computed tomography, X-ray Perfusion Stroke Brain ischemia Computed tomography angiography 

Abbreviations

A2

2nd segment of the anterior cerebral artery

ACA

Anterior cerebral artery

AIF

Arterial input function

AIS

Acute ischemic stroke

ASPECTS

Alberta Stroke Program Early CT Score

CBF

Cerebral blood flow

CBV

Cerebral blood volume

CT

Computed tomography

CTA

Computed tomography angiography

CTP

Computed tomography perfusion

DSA

Digital subtraction angiography

DWI

Diffusion-weighted imaging

ED

Emergency Department

ICA

Intracranial carotid artery

IV

Intravenous

M1

M1 segment of the middle cerebral artery

MCA

Middle cerebral artery

MRI

Magnetic resonance imaging

MTT

Mean transit time

PCA

Posterior cerebral artery

NCCT

Non-contrast-computed tomography

RAPID

RApid processing of PerfusIon and Diffusion

rCBF

relative cerebral blood flow

rCBF

relative cerebral blood volume

VOF

Venous outflow function

mCTA

multiphase CTA

sCTA

single phase CTA

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyMater Misericordiae University HospitalDublin 7Ireland
  2. 2.School of MedicineUniversity College DublinDublinIreland

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