March-April 2016

Introduction

CT Perfusion

Michael H. Lev

Michael H. Lev

In this issue of the AJNR News Digest, we highlight considerations regarding the use of CT perfusion (CTP) imaging for acute neurovascular assessment.

Although the idea of measuring cerebral perfusion by tracking a contrast bolus with rapid sequence imaging has been around since the earliest days of CT, in the mid/late 1970s,1 it was not … more »

Adult Brain—Interventional

Timing-Invariant CT Angiography Derived from CT Perfusion Imaging in Acute Stroke: A Diagnostic Performance Study

Ewoud J. Smit

Ewoud J. Smit

In acute stroke, CT angiography (CTA) and CT perfusion (CTP) are generally combined for their complementary information. Previously, we have demonstrated that CTA can be derived from CTP data with good image quality. So, we wondered if these derived CTA images could also be used for occlusion detection, and performed a diagnostic performance … more »

Brain

Cost-Effectiveness of CT Angiography and Perfusion Imaging for Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Pina C. Sanelli

Pina C. Sanelli

In this changing health care environment that emphasizes providing higher quality of care while lowering health care costs, it has become increasingly important for physicians to justify the imaging exams, diagnostic tests, and treatments they select for their patients. Because imaging utilization has risen dramatically in the past decade, the use of advanced imaging … more »

Brain

Predictors of Reperfusion in Patients with Acute Ischemic Stroke

Alexander D. Horsch

Alexander D. Horsch

Our study was part of the prospective multicenter Dutch acute stroke study (DUST), which was funded by the Netherlands Heart Foundation in collaboration with the MR CLEAN study, and received additional funding from the Nuts Ohra Foundation. The main aim of DUST was to investigate the use of advanced CT imaging (CTP and … more »

Brain

Exposing Hidden Truncation-Related Errors in Acute Stroke Perfusion Imaging

William A. Copen

William A. Copen

Perfusion imaging can reveal pathology that is otherwise invisible to the neuroradiologist’s eye. In acute stroke, CT- and MR-based perfusion imaging uniquely depict the alterations in microvascular blood flow that threaten brain tissue viability, and these techniques are increasingly used to direct the therapies that attempt to keep ischemic neurons alive. However, when … more »

Brain

Clinical Stroke Penumbra: Use of National Institutes of Health Stroke Scale as a Surrogate for CT Perfusion in Patient Triage for Intra-Arterial Middle Cerebral Artery Stroke Therapy

Jerrold L. Boxerman

Jerrold L. Boxerman

This paper explored whether CT perfusion (CTP) imaging significantly affected our decision to administer intra-arterial therapy (IAT) in patients with acute stroke beyond the information from noncontrast CT (NCCT), CT angiography (CTA), and the NIH Stroke Scale (NIHSS). This was a contentious issue in the neuroradiology community at the time of publication, and … more »

Patient-Tailored Perfusion Thresholds and Multimodal CT

Richard Aviv

Richard I. Aviv

Since its inception, I have been convinced of the extraordinary potential of CT perfusion imaging in acute stroke to improve upon the landmark NINDS and ECASS stroke studies that used noncontrast CT alone to define a target population for stroke thrombolysis. It is incumbent on all clinicians using CTP to understand the potential and limitations … more »