Advertisement

European Radiology

, Volume 13, Supplement 5, pp 117–120 | Cite as

Acute cerebral stroke imaging and brain perfusion with the use of high-concentration contrast media

  • K. A. MilesEmail author
Article

Abstract

Acute cerebral stroke remains a major cause of death among adults and the emergence of new therapies has created a need for early and rapid imaging at a time when conventional CT is either normal or demonstrates subtle abnormalities that are easy to misinterpret. Perfusion CT uses the temporal changes in cerebral and blood attenuation during a rapid series of images acquired without table movement following an intravenous bolus of contrast medium to generate images of mean transit time (MTT) cerebral blood volume (CBV) and perfusion. Reduced perfusion with preserved CBV is indicative of reversible ischaemia, whereas a matched reduction in perfusion and CBV implies infarction. The CT perfusion imaging can positively identify patients with nonhaemorrhagic stroke in the presence of a normal conventional CT, provide an indication as to prognosis and potentially select those patients for whom thrombolysis is appropriate. Perfusion CT offers a powerful adjunct to MDCT based imaging of cerebrovascular disease, but further clinical validation is required.

Keywords

Acute cerebral stroke Brain perfusion High-concentration contrast media Imaging 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Miles KA, Griffiths MR (2003) Perfusion CT: A worthwhile enhancement? Br J Radiol 76:220–231PubMedCrossRefGoogle Scholar
  2. 2.
    Keith C, Griffiths M, Petersen B, Anderson R, Miles K (2002) Computed tomography perfusion imaging in acute stroke. Australas Radiol 46:221–230PubMedCrossRefGoogle Scholar
  3. 3.
    Latchaw RE, Yonas H, Hunter GJ, Yuh WTC, Ueda T, Sorensen AG et al. (2003) Guidelines and recommendations for perfusion imaging in cerebral ischaemia. Stroke 34:1084–1104PubMedCrossRefGoogle Scholar
  4. 4.
    Tissue plasminogen activator for acute ischemic stroke (1995) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 333:1581–1587CrossRefGoogle Scholar
  5. 5.
    Hacke W, Kaste M, Fieschi C, Kummer R von, Davalos A, Meier D et al. (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352:1245–1251PubMedCrossRefGoogle Scholar
  6. 6.
    Gillard JH, Minhas PS, Hayball MP, Bearcroft PW, Antoun NM, Freer CE, Mathews JC, Miles KA, Pickard JD (2000) Assessment of quantitative computed tomographic cerebral perfusion imaging with H2(15)0 positron-emission tomography. Neurol Res 22:457–464PubMedGoogle Scholar
  7. 7.
    Cenic A, Nabavi DG, Craen RA, Gelb AW, Lee TY (1999) Dynamic CT measurement of cerebral blood flow: a validation study. Am J Neuroradiol 20:63–73PubMedGoogle Scholar
  8. 8.
    Wintermark M, Thiran JP, Maeder P, Schnyder P, Meuli R (2001) Simultaneous measurement of regional cerebral blood flow by perfusion CT and stable xenon CT: a validation study. Am J Neuroradiol 22:905–914PubMedGoogle Scholar
  9. 9.
    Cenic A, Nabavi DG, Craen RA, Gelb AW, Lee TY (2000) A CT method to measure hemodynamics in brain tumors: validation and application to cerebral blood flow maps. Am J Neuroradiol 21:462–470PubMedGoogle Scholar
  10. 10.
    Nabavi DG, Cenic A, Dool J, Smith RM, Espinosa F, Craen RA, Gelb AW, Lee TY (1999) Quantitative assessment of cerebral hemodynamics using CT: stability, accuracy, and precision studies in dogs. J Comput Assist Tomogr 23:506–515PubMedCrossRefGoogle Scholar
  11. 11.
    Gillard JH, Antoun NM, Burnet NG, Pickard JD (2001) Reproducibility of quantitative CT perfusion imaging. Br J Radiol 74:552–555PubMedGoogle Scholar
  12. 12.
    Roberts HC, Roberts TP, Smith WS, Lee TJ, Fischbein NJ, Dillon WP (2001) Multisection dynamic CT perfusion for acute cerebral ischemia: the “toggling-table” technique. Am J Neuroradiol 22:1077–1080PubMedGoogle Scholar
  13. 13.
    Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P et al. (2002) Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography at the time of emergency room admission in acute stroke patients. Ann Neurol 51:417–432PubMedCrossRefGoogle Scholar
  14. 14.
    Koenig M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L (2001) Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke 32:431–437PubMedCrossRefGoogle Scholar
  15. 15.
    Mayer TE, Hamann GF, Baranczyk J, Rosengarten B, Klotz E, Wiesmann M et al. (2000) Dynamic CT perfusion imaging of acute stroke. Am J Neuroradiol 21:1441–1449PubMedGoogle Scholar
  16. 16.
    Klotz E, Konig M (1999) Perfusion measurements of the brain: using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke. Eur J Radiol 30:170–184PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Wesley Research Institute, 2nd Floor Day Care CentreThe Wesley HospitalBrisbaneAustralia
  2. 2.Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK

Personalised recommendations