J Korean Radiol Soc.  2003 Oct;49(4):231-235. 10.3348/jkrs.2003.49.4.231.

The Utility of First-Pass Perfusion CT in Hyperacute Ischemic Stroke: Early Experience

• Lee TJ
• Lee MS
• Kim MS
• Hong IS
• Lee YH
• Lee JY
• Whang K

• KMID: 2199902
• DOI: http://doi.org/10.3348/jkrs.2003.49.4.231

Abstract

PURPOSE: To evaluate the findings of first-pass perfusion CT in hyperacute stroke patients and to determine the relationship between a perfusion map and final infarct outcome.
MATERIALS AND METHODS
Thirty-five patients admitted with ischemic stroke within six hours of the onset of symptoms underwent conventional cerebral CT immediately followed by first-pass perfusion CT. Nineteen underwent follow-up CT or MRI, and three types of dynamic perfusion map - cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) - were evaluated by two radiologists. In these 19 patients, initial perfusion maps correlated with final infarct size, determined during follow-up studies.
RESULTS
In all 35 patients, major large vessel perfusion abnormalities [middle cerebral artery - MCA MCA and anterior cerebral artery - ACA (n=2); posterior cerebral artery - PCA (n=8)] were detected. On first-pass perfusion maps depicting CBF and MTT, all lesions were detected, and CBF and delayed MTT values were recorded. CBV maps showed variable findings. In all 19 patients who were followed up, the final infarct size of perfusion abnormalities was less than that depicted on CBF and MTT maps, and similar to or much greater than that seen on CBV maps.
CONCLUSION
First-pass perfusion CT scanning is a practical, rapid and advanced imaging technique. In hyperacute stroke patients, it provides important and reliable hemodynamic information as to which brain tissue is salvageable by thrombolytic therapy, and predicts outcome of such treatment.

Keyword

Brain, ischemia; Cerebral infarction; Computed tomography (CT), helical

MeSH Terms

Anterior Cerebral Artery
Blood Volume
Brain
Cerebral Arteries
Cerebral Infarction
Follow-Up Studies
Hemodynamics
Humans
Magnetic Resonance Imaging
Passive Cutaneous Anaphylaxis
Perfusion*
Posterior Cerebral Artery
Stroke*
Thrombolytic Therapy
Tomography, X-Ray Computed