Purpose
To describe the brain perfusion patterns,
using multimodal imaging technique in acute stroke patients with stenotic changes of extracranial internal carotid artery.
Methods and Materials
A 64 row multislice CT system was used for the evaluation of113 acute stroke patients 9 hours after ictus,
using multimodal imaging (CT,
CTA,
CTP) and follow up CT within 24 hours.Patients were evaluated considering time of stroke,
collaterals (good vs.
poor),
occlusion site,
lesion size (ASPECTS scale on CTP),
clinicalstatus(NIHSS scale)and correlation to the grade of stenotic changes (NASCET) in extracranial blood vessels seen on CTA.
Control group include patients with stroke,
but no signs of atherosclerotic changes of extracranial blood vesselsseen onCTA.
Core...
Results
All patients were examined during 9 hours after ictus,
mean time was 203 ±98 minutes or aproximately 3,5 hours,
(see Fig.
1).
7 patients were excluded from further analysis due to motion artifacts during examination.
19 patients had posterior circulation stroke,
87 patients had ACM territory strokes,
latter were further evaluated in details by CT perfusion automated postprocessing software.
34 patients from those had no atherosclerotic changes of extracranial vessels (39,1%).
42,5% cases (n=37) had moderate stenosis till 49% of the lumen. Few cases 4,6%...
Conclusion
Optimal acute stroke CT perfusion imaging interpretation requires selection of appropriate thresholds and choice of most appropriate parameters for definition of penumbra,
core.
Lesion severity and possible outcomesof individual brain perfusion patterns in acute stroke must beevaluated using combination of CTP maps,
collateral blood supply patterns in comparison to extracranial vessel stenosis grade.
References
1. Souza LCS,
Yoo AJ,
Chaudhry ZA.
Payabvash S,
Kemmling A,
Schaefer PW,
Hirsch JA,
Furie KL,
Gonzalez RG,
Nogueira RG,
Lev MH.
Malignant CTA Collateral Profile Is Hihgly Specific for Large Admission DWI Infarct Core and Poor Outcome in Acute Stroke,
Am J Neuroradiol 33:1331-36 (8),
2012.
2.
Aviv RI,
Mandelcorn J,
Chakraborty S,
Gladstone D,
Malham S,
Tomlinson G,
Fox AJ,
Symons S.
Alberta Stroke Program Early CT Scoring of CT perfusion in early stroke visualization and assessment.
AJNR Am J Neuroradiol.
2007...
Personal Information
Maija Radzina
Radiologist at Diagnostic Radiology Institute,
Paula Stradins clinical university hospital,
Riga,
Latvia
e-mail:
[email protected]