Perfusion Imaging in Acute Ischemic Stroke: Let Us Improve the Science before Changing Clinical Practice

Departments of Radiology and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Radiology (Impact Factor: 6.87). 01/2013; 266(1):16-21. DOI: 10.1148/radiol.12112134
Source: PubMed
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Available from: Bijoy K Menon, Sep 16, 2015
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    • "Cerebral computed tomography perfusion (CTP) scans are acquired in patients with acute stroke [1] or subarachnoid hemorrhage [2]. Although there is some debate [2] [3] [4] [5] about the prognostic value of CT perfusion, many studies [1, 2, 6–9] have shown that it provides valuable information about the cerebral hemodynamics, especially with the introduction of 320-slice CT scanners (16 cm coverage) that enable the acquisition of whole-brain CTP scans and provide an option to derive 4D dynamic CT angiography (dCTA) images from the CTP scans [9] [10] [11] [12]. These 4D dCTA images show great potential for the assessment of collaterals [13], the measurement of cerebral circulation times [14], and arteriovenous shunting lesion assessment [15]. "
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    ABSTRACT: Background and Purposes. The 320-detector row CT scanner enables visualization of whole-brain hemodynamic information (dynamic CT angiography (CTA) derived from CT perfusion scans). However, arterial image quality in dynamic CTA (dCTA) is inferior to arterial image quality in standard CTA. This study evaluates whether the arterial image quality can be improved by using a total bolus extraction (ToBE) method. Materials and Methods. DCTAs of 15 patients, who presented with signs of acute cerebral ischemia, were derived from 320-slice CT perfusion scans using both the standard subtraction method and the proposed ToBE method. Two neurointerventionalists blinded to the scan type scored the arterial image quality on a 5-point scale in the 4D dCTAs in consensus. Arteries were divided into four categories: (I) large extradural, (II) intradural (large, medium, and small), (III) communicating arteries, and (IV) cerebellar and ophthalmic arteries. Results. Quality of extradural and intradural arteries was significantly higher in the ToBE dCTAs than in the standard dCTAs (extradural , large intradural , medium intradural , and small intradural ). Conclusion. The 4D dCTAs derived with the total bolus extraction (ToBE) method provide hemodynamic information combined with improved arterial image quality as compared to standard 4D dCTAs.
    Full-text · Article · Oct 2014 · BioMed Research International
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    ABSTRACT: Despite high rates of early revascularization with intra-arterial stroke therapy, the clinical efficacy of this approach has not been clearly demonstrated. Neuroimaging biomarkers will be useful in future trials for patient selection and for outcomes evaluation. To identify patients who are likely to benefit from intra-arterial therapy, the combination of vessel imaging, infarct size quantification and degree of neurologic deficit appears critical. Perfusion imaging may be useful in specific circumstances, but requires further validation. For measuring treatment outcomes, surrogate biomarkers that appear suitable are angiographic reperfusion as measured by the modified Thrombolysis in Cerebral Infarction scale and final infarct volume.
    No preview · Article · Jan 2013 · Cardiovascular Engineering and Technology
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