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Research ArticleBrain

Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies

Jürgen R. Reichenbach, Joachim Röther, Lars Jonetz-Mentzel, Michael Herzau, Anke Fiala, Cornelius Weiller and Werner A. Kaiser
American Journal of Neuroradiology November 1999, 20 (10) 1842-1850;
Jürgen R. Reichenbach
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Joachim Röther
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Lars Jonetz-Mentzel
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Michael Herzau
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Anke Fiala
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Cornelius Weiller
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Werner A. Kaiser
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    fig 1.

    Patient 6.

    A, Initial native CT scan shows standardized circular ROIs, which were manually placed in both hemispheres in the vascular territories of the ACA, MCA, PCA, the basal ganglia region, and the thalamus.

    B, Enhancement-versus-time curves of ROIs 1 and 2 located symmetrically in the anterior vascular territory of the MCA in the ischemic and healthy areas, respectively. Note the strong enhancement peak indicating the passage of the compact contrast bolus in the normal area (ROI 2). Conversely, the time course of the contralateral ROI (ROI 1) shows a markedly delayed and slow enhancement, indicating hypoperfusion.

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    fig 2.

    Initial native CT scans and corresponding time-to-peak parameter maps. The maps are color-coded with values ranging from 5 to 40 seconds.

    A, Patient 6: 62-year-old woman who presented 40 minutes after onset of left hemiparesis. The CT scan is normal. Note the clear demarcation of the diseased area in the right hemisphere, corresponding to the right ACA and MCA territories, including the basal ganglia on the parameter map.

    B, Patient 17: 77-year-old woman who presented 40 minutes after onset of somnolence and left hemiparesis. The native CT scan is normal. The parameter map shows an area of delayed perfusion in the territory of the right MCA.

    C, Patient 1: 60-year-old man who had a normal CT scan 2.8 hours after onset. The time-to-peak map depicts a large perfusion deficit in the left MCA territory, including the basal ganglia.

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    fig 3.

    Patient 10: initial and follow-up examinations.

    A, 2 hours 50 minutes after onset.

    B, 30 hours after onset, during therapy with heparin. The patient suffered from a large infarct in the left hemisphere with global aphasia and right hemiparesis. The first native CT scan (A) reveals only discrete cortical hypodensity and effacement of cortical sulci in the ischemic hemisphere. In contrast, the time-to-peak map clearly shows the extent of the affected brain area, which corresponds strongly to the hypodensity seen on the CT scan in the follow-up study (B). The time-to-peak map shows tissue reperfusion 30 hours later. A large MCA infarction developed despite recanalization.

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    TABLE 1:

    Clinical data of patients

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    TABLE 2:

    Clinical data and hemispheric lesion areas (HLA) during initial and follow-up scans

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American Journal of Neuroradiology
Vol. 20, Issue 10
1 Nov 1999
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Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies
Jürgen R. Reichenbach, Joachim Röther, Lars Jonetz-Mentzel, Michael Herzau, Anke Fiala, Cornelius Weiller, Werner A. Kaiser
American Journal of Neuroradiology Nov 1999, 20 (10) 1842-1850;

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Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies
Jürgen R. Reichenbach, Joachim Röther, Lars Jonetz-Mentzel, Michael Herzau, Anke Fiala, Cornelius Weiller, Werner A. Kaiser
American Journal of Neuroradiology Nov 1999, 20 (10) 1842-1850;
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  • Perfusion-CT Assessment of Infarct Core and Penumbra: Receiver Operating Characteristic Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke
  • Visual evaluation of perfusion computed tomography in acute stroke accurately estimates infarct volume and tissue viability
  • Accuracy of Dynamic Perfusion CT with Deconvolution in Detecting Acute Hemispheric Stroke
  • Prediction of Neurologic Deterioration in Patients with Lacunar Infarction in the Territory of the Lenticulostriate Artery Using Perfusion CT
  • Bedside assessment of cerebral perfusion reductions in patients with acute ischaemic stroke by near-infrared spectroscopy and indocyanine green
  • Correlation of Early Dynamic CT Perfusion Imaging with Whole-Brain MR Diffusion and Perfusion Imaging in Acute Hemispheric Stroke
  • Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke
  • Safety and Feasibility of a CT Protocol for Acute Stroke: Combined CT, CT Angiography, and CT Perfusion Imaging in 53 Consecutive Patients
  • Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association
  • Computed Tomographic Findings in Patients Undergoing Intra-arterial Thrombolysis for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: Results From the PROACT II Trial * Editorial Comment: Results From the PROACT II Trial
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  • Multisection Dynamic CT Perfusion for Acute Cerebral Ischemia: The "Toggling-table" Technique
  • Correlation of Cerebrovascular Reserve as Measured by Acetazolamide-challenged SPECT with Angiographic Flow Patterns and Intra- or Extracranial Arterial Stenosis
  • Quantitative Assessment of the Ischemic Brain by Means of Perfusion-Related Parameters Derived From Perfusion CT
  • Intraarterial Thrombolysis: Ready for Prime Time?
  • Perfusion Mapping Using Computed Tomography Allows Accurate Prediction of Cerebral Infarction in Experimental Brain Ischemia Editorial Comment
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