Principles and Practical Application of Brain CT in Acute Ischemic Stroke

  • Abdulaziz S. Al Sultan
  • Muneer Eesa
  • Bijoy K. Menon
Chapter
First Online:
Part of the Stroke Revisited book series (STROREV)

Abstract

Stroke is a leading cause of mortality and morbidity worldwide. Available effective therapies rely on imaging for decision making. Recent advances in the field now enable physicians to select appropriate patients for acute ischemic stroke treatment. Computed tomography continues to be the standard imaging modality in acute ischemic stroke assessment in most centers worldwide. Six recently published randomized trials, showing strong benefit from endovascular treatment in acute ischemic stroke, have mostly used computed tomography for patient selection. In this chapter, we will discuss non-contrast computed tomography, computed tomography angiography, and computed tomography perfusion imaging in patients with acute ischemic stroke. The different diagnostic, therapeutic, and prognostic implications, as well as the advantages and disadvantages of these modalities, will also be discussed.

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References

  1. 1.
    Menon BK, Puetz V, Kochar P, et al. ASPECTS and other neuroimaging scores in the triage and prediction of outcome in acute stroke patients. Neuroimaging Clin N Am. 2011;21:407–23.CrossRefPubMedGoogle Scholar
  2. 2.
    Puetz V, Sylaja PN, Coutts SB, et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke. 2008;39:2485–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Shobha N, Bal S, Boyko M, et al. Measurement of length of hyperdense MCA sign in acute ischemic stroke predicts disappearance after IV tPA. J Neuroimaging. 2014;24:7–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15:1138–47.CrossRefPubMedGoogle Scholar
  5. 5.
    Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Holodinsky JK, Yu AY, Assis ZA, et al. History, evolution, and importance of emergency endovascular treatment of acute ischemic stroke. Curr Neurol Neurosci Rep. 2016;16:42.CrossRefPubMedGoogle Scholar
  7. 7.
    Qazi E, Al-Ajlan FS, Najm M, et al. The role of vascular imaging in the initial assessment of patients with acute ischemic stroke. Curr Neurol Neurosci Rep. 2016;16:32.CrossRefPubMedGoogle Scholar
  8. 8.
    Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316:1279–88.CrossRefPubMedGoogle Scholar
  9. 9.
    Menon BK, Demchuk AM. Computed tomography angiography in the assessment of patients with stroke/TIA. Neurohospitalist. 2011;1:187–99.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Eswaradass P, Appireddy R, Evans J, et al. Imaging in acute stroke. Expert Rev Cardiovasc Ther. 2016;14:963–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Demchuk AM, Menon BK, Goyal M. Comparing vessel imaging: noncontrast computed tomography/computed tomographic angiography should be the new minimum standard in acute disabling stroke. Stroke. 2016;47:273–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Menon BK, d’Esterre CD, Qazi EM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology. 2015;275:510–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Menon BK, Qazi E, Nambiar V, et al. Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the interventional management of stroke III trial. Stroke. 2015;46:1239–44.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bal S, Bhatia R, Menon BK, et al. Time dependence of reliability of noncontrast computed tomography in comparison to computed tomography angiography source image in acute ischemic stroke. Int J Stroke. 2015;10:55–60.CrossRefPubMedGoogle Scholar
  15. 15.
    d’Esterre CD, Boesen ME, Ahn SH, et al. Time-dependent computed tomographic perfusion thresholds for patients with acute ischemic stroke. Stroke. 2015;46:3390–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  • Abdulaziz S. Al Sultan
    • 1
  • Muneer Eesa
    • 2
  • Bijoy K. Menon
    • 1
  1. 1.Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  2. 2.Department of RadiologyUniversity of CalgaryCalgaryCanada

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