Open AccessComputed Tomographic Angiography and Computed Tomographic Perfusion Imaging of Hyperacute Stroke
Author(s) -
Michael H. Lev,
Steven J. Nichols
Publication year - 2000
Publication title -
topics in magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.547
H-Index - 53
eISSN - 1536-1004
pISSN - 0899-3459
DOI - 10.1097/00002142-200010000-00004
Subject(s) - medicine , thrombolysis , radiology , triage , magnetic resonance imaging , angiography , stroke (engine) , perfusion scanning , perfusion , computed tomographic angiography , cerebral angiography , nuclear medicine , myocardial infarction , mechanical engineering , emergency medicine , engineering
The roles of noncontrast computed tomography (NCCT) and CT angiographic/CT perfusion (CTA/CTP) imaging in the rapid triage of clinically suspected hyperacute stroke patients to appropriate therapy is reviewed. Contraindications to thrombolysis include NCCT hemorrhage (absolute) and significant parenchymal hypodensity (relative). The sensitivity of NCCT for early (<6 h) stroke detection, higher than that of conventional magnetic resonance imaging, is improved further by using nonstandard window and level review settings. CTA/CTP is fast and convenient, adding approximately 10 min to the NCCT examination. CTA/CTP's accuracy in diagnosing ischemia and localizing thrombus to proximal or distal intracranial vessels far exceeds that of clinical examination (including National Institutes of Health stroke scale use), facilitating triage of appropriate candidates to intra-arterial thrombolysis. The size of the ischemic CTP hypodensity (proportional to reduced cerebral blood volume) predicts final infarct volume and clinical outcome; its location can guide the decision to perform intra-arterial thrombolysis, intravenous thrombolysis, or other treatment.