Accuracy of Dynamic Perfusion CT with Deconvolution in Detecting Acute Hemispheric Stroke
Max Wintermarka,c,
Nancy J. Fischbeina,
Wade S. Smithb,
Nerissa U. Kob,
Marcel Quistd and
William P. Dillona
a Department of Radiology, Neuroradiology Section, University of California, San Francisco
b Department of Neurology, Neurovascular Service, University of California, San Francisco
c Department of Diagnostic and Interventional Radiology, University Hospital Center, Lausanne, Switzerland
d Medical IT–Advanced Development, Philips Medical Systems, Best, the Netherlands
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FIG 1. 55-year-old man with right homonymous hemianopsia and right-body hemisensory loss. Admission nonenhanced CT 6 hours after symptom onset was unremarkable (both reviewers), except for an attenuated left PCA (arrowheads, one reviewer). PCT shows prolonged MTT and reduced rCBF in the left PCA territory. rCBVs are reduced only in a small part of the left thalamus but are increased in the rest of the PCA territory. The areas correspond to infarct and penumbra on the computerized automated map. Figure and legend continues.
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FIG 1. Continued.—Admission CTA shows an occluded left P1 segment, which had recanalized but remained focally stenotic on follow-up MR angiography 3 days later. Follow-up DW image shows completed stroke in the predicted left thalamic infarct core. The penumbra did not infarct, most likely because of early recanalization; the MTT and rCBF abnormalities were however, categorized as false-positive since delayed MR imaging was selected as the criterion standard.
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FIG 2. 77-year-old woman with acute-onset left hemiparesis. Admission nonenhanced CT 2 hours after onset is normal. TTP and MTT are prolonged in the right superficial MCA territory (arrows). rCBFs are normal, but rCBVs are higher than contralateral values. TTP and MTT changes are not explained by any vascular abnormality; right carotid bifurcation (arrowhead) and intracranial arteries are normal. Final diagnosis was TIA. Follow-up CT 14 days later was normal. TTP and MTT changes were regarded as false-positive and most likely related to luxury perfusion due to TIA.
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