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P17 Computed tomography (CT) has experienced a revival for  perfusion assessment in acute stroke. However, so far it is limited by  its small anatomical coverage. We studied a toggling table approach to  (multislice) dynamic perfusion CT for extended coverage in patients  with suspected acute MCA ischemia. In 20 patients with suspected acute  MCA ischemia, a dynamic CT perfusion scan was performed on a  multidetector scanner. To increase anatomical coverage, 2 distinct  “toggling” table positions (each consisting of two 1cm slices) were  chosen to represent the MCA territory and scanned in an alternating  fashion during the bolus injection of 40mL contrast agent. Dynamic  images were evaluated on a ROI and pixel-by-pixel basis, estimating  peak density change, time to peak (TTP), integral (rCBV), mean transit  time (MTT), and flow (rCBF). Acutely acquired CT perfusion data were  compared with follow-up CT or MR (perfusion and diffusion) images. With  the toggling table approach, temporal resolution is reduced to  approximately 5 secs. Four imaging slices at two distinct locations can  be obtained, covering the MCA territory. In 15 patients, perfusion CT  revealed focal abnormalities in at least one slice, most commonly on  MTT maps. In 14 of these 15 patients, the area of perfusion abnormality  was a good predictor of the ultimate infarct. A single table location  approach would have underestimated or missed the involved tissue in  most cases. In 5 of the 20 patients, perfusion maps failed to delineate  any abnormality: in 4 cases, MRI confirmed the absence of ischemia, in  1 case, CT failed to reveal a small ischemic injury visible on  diffusion MRI. Addition of the dynamic CT perfusion scan adds less than  5 minutes to a CT stroke protocol and can be coupled with CTA studies  to image the cervical and cerebral vasculature in acute stroke. The  dynamic CT perfusion technique is a practical and useful tool for the  emergency assessment of acute stroke patients. By employing the  toggling table approach, perfusion information can be obtained over an  extended anatomic area and thus reveal the presence and the extent of  presumed tissue ischemia.

Dynamic CT perfusion for acute cerebral ischemia: increasing anatomical coverage with the “toggling table” technique