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CT Perfusion in Acute Stroke: “Black Holes” on Time‐to‐Peak Image Maps Indicate Unsalvageable Brain
Author(s) -
Meagher Ruairi,
Shankar Jai Jai Shiva
Publication year - 2016
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12352
Subject(s) - medicine , perfusion scanning , cerebral blood flow , perfusion , acute stroke , ischemia , stroke (engine) , neuroimaging , brain tissue , brain ischemia , blood flow , radiology , nuclear medicine , cardiology , mechanical engineering , psychiatry , tissue plasminogen activator , engineering
BACKGROUND AND PURPOSE CT perfusion is becoming important in acute stroke imaging to determine optimal patient‐management strategies. The purpose of this study was to examine the predictive value of time‐to‐peak image maps and, specifically, a phenomenon coined a “black hole” for assessing infarcted brain tissue at the time of scan. METHODS Acute stroke patients were screened for the presence of black holes and their follow‐up imaging (noncontrast CT or MR) was reviewed to assess for infarcted brain tissue. RESULTS Of the 23 patients with signs of acute ischemia on CT perfusion, all had black holes. The black holes corresponded with areas of infarcted brain on follow‐up imaging (specificity 100%). Black holes demonstrated significantly lower cerebral blood volumes ( P < .001) and cerebral blood flow ( P < .001) compared to immediately adjacent tissue. CONCLUSIONS Black holes on time‐to‐peak image maps represent areas of unsalvageable brain.