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Dynamic CT Perfusion Imaging of Acute Stroke

Thomas E. MayerGo,a, Gerhard F. Hamanna, Jan Baranczyka, Bernhard Rosengartena, Erich Klotza, Martin Wiesmanna, Ulrich Misslera, Gernot Schulte-Altedorneburga and Hartmuth J. Brueckmanna

a From the Departments of Neuroradiology (T.E.M., H.J.B.) and Neurology (G.F.H.), Ludwig-Maximilians University, Munich; the Neuroradiology Section (J.B., M.W., U.M., G.S.-A.) and Clinic of Neurology (B.R.), Medical University, Lübeck; and the Medical Engineering Group (E.K.), Siemens, Erlangen, Germany.



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  		FIG 1. Two perfusion sections in a case of left MCA occlusion. Three hours before undergoing the examination, this 61-year-old woman experienced acute right hemiplegia and global aphasia during coronary angiography.

A, Early conventional CT scans appear normal, with no signs of swelling or discrete cortical hypodensity.

B, CBF maps show flow reduction in nearly the whole cortical territory of the left MCA. Temporal (B2), severe; parietal (B1), moderate to severe. Note that there is a mismatch with the ECTS (color code: red, blood vessels; green, normal cortex; blue, normal white matter; violet, low flow area).

C, CBV maps also show ischemia, although less clearly in the central parietal region because of decreased contrast (color code: red, blood vessels; green, normal cortex; blue, normal white matter; violet, low flow area).

D, TTP concentration of contrast enhancement maps show time delay in the cortical territory of the left MCA and artifact in areas where no peak is discernible (color code: blue, segmented blood vessels, normal cortex; dark green, normal white matter; light green, yellow, and red, low flow area).

E, Follow-up CT scan, obtained 1 day after stroke, shows infarction in the former ischemic portion of the cortical territory of the MCA. Temporal (B2), complete; central/parietal (B1), patchy.



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  		FIG 2. Three perfusion sections. Occlusion of a left MCA branch and of the ipsilateral ICA. This 62-year-old man was admitted with right hemiparesis and aphasia 8 hours after the onset of symptoms. The color-coding is similar to that used in figure 1.

A, Early conventional CT scans appear normal, although retrospectively, a discrete hypodense area can be seen in the cortex (A2).

B, CBF maps show severe flow reduction in the fronto-opercular territory of the left MCA.

C, CBV maps show the ischemic region to be less pronounced and indicate a 10% increase in blood volume in the surrounding cortex, which compensated for the reduced flow velocity in the territory of the left carotid artery.

D, TTP concentration of contrast enhancement maps show time delay not only in the ischemic zone but also in the territories of the entire left MCA and anterior cerebral artery due to occlusion of the ICA, as revealed by sonography. Acute left carotid artery occlusion might have led to embolization in a frontal branch of the MCA.

E, Follow-up CT scans, obtained 3 days after stroke, show a small infarct representing the former ischemic area of the frontal cortical territory of the MCA (red arrowheads).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X