Skip to main content
SpringerLink
Log in

Stroke/Cerebral Perfusion CT: Technique and Clinical Applications

  • Chapter
  • First Online:
Book cover Multislice CT

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Perfusion computed tomography (PCT) has revolutionized CT imaging, broadened its applications, and provided important adjuncts to existing evaluation modalities. The fundamental principle of PCT is that iodinated contrast flow follows blood flow through the brain, entering in the arterial phase, disseminating through tissues in the capillary phase, and exiting the brain via the venous system. Factors affecting blood flow in or out of brain tissues will similarly affect contrast flow through the system. PCT is used extensively in evaluation of acute ischemic stroke patients for improved stroke diagnosis, assessment of core infarction and viable but hypoperfused tissue (penumbra), but also for vasospasm, tumors, and traumatic brain injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Abuzayed B, Al-Abadi H, Al-Otti S, Baniyaseen K, Al-Sharki Y (2014) Neuronavigation-guided endoscopic endonasal resection of extensive skull base mucormycosis complicated with cerebral vasospasm. J Craniofac Surg 25:1319–1323

    Article  PubMed  Google Scholar 

  • Berkhemer OA, Fransen PS, Beumer D et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20

    Article  PubMed  Google Scholar 

  • Broderick JP, Palesch YY, Demchuk AM et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903

    Article  CAS  PubMed  Google Scholar 

  • Campbell BC, Mitchell PJ, Kleinig TJ et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018

    Article  CAS  PubMed  Google Scholar 

  • Chen Y, Xu W, Guo X et al (2016) CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass). Eur Radiol 26:254–261

    Article  PubMed  Google Scholar 

  • Ciccone A, Valvassori L, Nichelatti M et al (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368:904–913

    Article  CAS  PubMed  Google Scholar 

  • Dai DW, Zhao WY, Zhang YW et al (2013) Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease. Neuroradiology 55:1431–1438

    Article  PubMed  Google Scholar 

  • Ding B, Ling HW, Chen KM, Jiang H, Zhu YB (2006) Comparison of cerebral blood volume and permeability in preoperative grading of intracranial glioma using CT perfusion imaging. Neuroradiology 48:773–781

    Article  PubMed  Google Scholar 

  • Dorsch NW, King MT (1994) A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage part I: incidence and effects. J Clin Neurosci 1:19–26

    Article  CAS  PubMed  Google Scholar 

  • Endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). National Library of Medicine (US), (2016). Accessed 29 Oct 2016

    Google Scholar 

  • Fung SH, Roccatagliata L, Gonzalez RG, Schaefer PW (2011) MR diffusion imaging in ischemic stroke. Neuroimaging Clin N Am 21:345–377. xi

    Article  PubMed  Google Scholar 

  • Gelfand JM, Wintermark M, Josephson SA (2010) Cerebral perfusion-CT patterns following seizure. Eur J Neurol 17:594–601

    Article  CAS  PubMed  Google Scholar 

  • Goyal M, Demchuk AM, Menon BK et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030

    Article  CAS  PubMed  Google Scholar 

  • Gu Y, Ni W, Jiang H et al (2012) Efficacy of extracranial-intracranial revascularization for non-moyamoya steno-occlusive cerebrovascular disease in a series of 66 patients. J Clin Neurosci 19:1408–1415

    Article  PubMed  Google Scholar 

  • Hedna VS, Stead LG, Bidari S et al (2012) Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes. Int J Emerg Med 5:12

    Article  PubMed  Google Scholar 

  • Heit JJ, Wintermark M (2016) Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke 47:1153–1158

    Article  PubMed  Google Scholar 

  • Huang AP, Tsai JC, Kuo LT et al (2014) Clinical application of perfusion computed tomography in neurosurgery. J Neurosurg 120:473–488

    Article  PubMed  Google Scholar 

  • Jain R (2011) Perfusion CT imaging of brain tumors: an overview. AJNR Am J Neuroradiol 32:1570–1577

    Article  CAS  PubMed  Google Scholar 

  • Jovin TG, Chamorro A, Cobo E et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306

    Article  CAS  PubMed  Google Scholar 

  • Kidwell CS, Jahan R, Gornbein J et al (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368:914–923

    Article  CAS  PubMed  Google Scholar 

  • Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA (2014) Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 120:1326–1339

    Article  PubMed  Google Scholar 

  • Lansberg MG, Straka M, Kemp S et al (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11:860–867

    Article  PubMed  Google Scholar 

  • Malinova V, Dolatowski K, Schramm P, Moerer O, Rohde V, Mielke D (2016) Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage. J Neurosurg 125:128–136

    Article  PubMed  Google Scholar 

  • McVerry F, Dani KA, MacDougall NJ, MacLeod MJ, Wardlaw J, Muir KW (2014) Derivation and evaluation of thresholds for core and tissue at risk of infarction using CT perfusion. J Neuroimaging 24:562–568

    Article  PubMed  Google Scholar 

  • Mishra NK, Christensen S, Wouters A et al (2015) Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy. Stroke 46:1245–1249

    Article  PubMed  Google Scholar 

  • Ohno T, Kudo K, Zaharchuk G, Fujima N, Shirato H (2016) Evaluation of diagnostic accuracy in CT perfusion analysis in moyamoya disease. Jpn J Radiol 34:28–34

    Article  PubMed  Google Scholar 

  • Prezzi D, Khan A, Goh V (2015) Perfusion CT imaging of treatment response in oncology. Eur J Radiol 84:2380–2385

    Article  PubMed  Google Scholar 

  • Reznik M, Saeed Y, Shutter L (2016) Teaching neuroImages: severe vasospasm in traumatic brain injury. Neurology 86:e132–e133

    Article  PubMed  Google Scholar 

  • Saver JL, Goyal M, Bonafe A et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295

    Article  CAS  PubMed  Google Scholar 

  • Tamrazi B, Shiroishi MS, Liu CS (2016) Advanced imaging of intracranial meningiomas. Neurosurg Clin N Am 27:137–143

    Article  PubMed  Google Scholar 

  • Tian B, Xu B, Liu Q, Hao Q, Lu J (2013) Adult Moyamoya disease: 320-multidetector row CT for evaluation of revascularization in STA-MCA bypasses surgery. Eur J Radiol 82:2342–2347

    Article  PubMed  Google Scholar 

  • Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) N Engl J Med 333:1581–1587

    Google Scholar 

  • Trevo and medical management versus medical management alone in wake up and late presenting strokes (DAWN). National Library of Medicine (US), (2000). Accessed 29 Oct 2016

    Google Scholar 

  • Wintermark M, Smith WS, Ko NU, Quist M, Schnyder P, Dillon WP (2004a) Dynamic perfusion CT: optimizing the temporal resolution and contrast volume for calculation of perfusion CT parameters in stroke patients. AJNR Am J Neuroradiol 25:720–729

    PubMed  Google Scholar 

  • Wintermark M, van Melle G, Schnyder P et al (2004b) Admission perfusion CT: prognostic value in patients with severe head trauma. Radiology 232:211–220

    Article  PubMed  Google Scholar 

  • Wintermark M, Ko NU, Smith WS, Liu S, Higashida RT, Dillon WP (2006) Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management. AJNR Am J Neuroradiol 27:26–34

    CAS  PubMed  Google Scholar 

  • Wintermark M, Albers GW, Alexandrov AV et al (2008) Acute stroke imaging research roadmap. Stroke 39:1621–1628

    Article  PubMed  Google Scholar 

  • Yeung TP, Bauman G, Yartsev S, Fainardi E, Macdonald D, Lee TY (2015) Dynamic perfusion CT in brain tumors. Eur J Radiol 84:2386–2392

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Neurosurgery, Stanford, CA, USA

    Adrienne Moraff MD, Jeremy Heit MD, PhD & Max Wintermark MD

Authors
  1. Adrienne Moraff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Heit MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max Wintermark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Max Wintermark MD .

Editor information

Editors and Affiliations

  1. Department of Radiology, Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany

    Konstantin Nikolaou

  2. Department of Diagnostic and Interventional Radiology, University of Freiburg, Freiburg, Germany

    Fabian Bamberg

  3. Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” – University of Rome, Rome, Italy

    Andrea Laghi

  4. Department of Radiology, Duke University School of Medicine, Durham, NC, USA

    Geoffrey D. Rubin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Moraff, A., Heit, J., Wintermark, M. (2017). Stroke/Cerebral Perfusion CT: Technique and Clinical Applications. In: Nikolaou, K., Bamberg, F., Laghi, A., Rubin, G.D. (eds) Multislice CT. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_16

Download citation

  • DOI: https://doi.org/10.1007/174_2017_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42585-6

  • Online ISBN: 978-3-319-42586-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation