Supratentorial Dynamic Computed Tomography for the Diagnosis of Vertebrobasilar Ischemic Stroke

Nagahori, Takeshi; Hirashima, Yutaka; Umemura, Kimiko; Nishijima, Michiharu; Kuwayama, Naoya; Kubo, Michinori; Endo, Shunro

doi:10.2176/nmc.44.105

Cited by 13 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,20 We have recently demonstrated that CTA-SIs increase the sensitivity for early ischemic changes in the posterior circulation compared with noncontrast CT. 12,16 Compared with CTA-SI, perfusion CT techniques may provide additional diagnostic and prognostic information in patients with acute posterior circulation stroke. 21,22 The comparison of CTA, perfusion CT, and multimodal MRI to predict functional outcome and treatment response in patients with BAO could be the subject of future studies.…”

Section: Discussionmentioning

confidence: 99%

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Puetz

Khomenko

Hill

et al. 2011

Stroke

102

View full text Add to dashboard Cite

on behalf of the Basilar Artery International Cooperation Study (BASICS) GroupBackground and Purpose-The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods-BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at Ն8 versus Ͻ8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0 -3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0 -2). Results-Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS Ն8. Patients with a pc-ASPECTS Ն8 more often had a favorable outcome than patients with a pc-ASPECTS Ͻ8 (crude RR, 1.7; 95% CI, 0.98 -3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS Ն8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8 -2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5-0.98) and functional independence (RR, 2.0; 95% CI, 1.1-3.8). In post hoc analysis, pc-ASPECTS dichotomized at Ն6 versus Ͻ6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2-7.5). Conclusions-pc-ASPECTS

show abstract

Section: Discussionmentioning

confidence: 99%

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Puetz

Khomenko

Hill

et al. 2011

Stroke

102

View full text Add to dashboard Cite

show abstract

“…The MR-angiographic view of the cervical vessels is very similar to the CT-angiographic one D30 present, PCT has demonstrated 95% accuracy in the delineation of the extent of supratentorial strokes, despite its limited spatial coverage [24]. PCT has also been demonstrated as useful in the evaluation of vertebro-basilar ischemia [25].…”

Section: Fig 1 Amentioning

confidence: 99%

Brain perfusion-CT in acute stroke patients

Wintermark

2005

Eur Radiol Suppl

View full text Add to dashboard Cite

The role of neuro-imaging in the evaluation of acute stroke has changed dramatically in the past decade. Previously, neuro-imaging was used in this setting to provide anatomic imaging that indicated the presence or absence of acute cerebral ischemia and excluded lesions that produce symptoms or signs mimicking those of stroke, such as hemorrhage and neoplasms. More recently, the introduction of thrombolysis has changed the goals of neuro-imaging from providing solely anatomic information to providing physiologic information that could help to determine which patients might benefit from therapy. In particular, significant emphasis has been placed on the delineation of the ischemic penumbra, also called tissue at risk. Modern CT survey, consisting of three indissociable elements: noncontrast CT (NCT) of course, perfusion-CT (PCT) and CT-angiography (CTA), fulfill all the requirements for hyperacute stroke imaging. CTA can define the occlusion site, depict arterial dissection, grade collateral blood flow, and characterize atherosclerotic disease, whereas PCT accurately delineates the infarct core and the ischemic penumbra. CT offers a number of practical advantages over other cerebral perfusion imaging methods, including its wide availability. Using PCT and CTA to define new individualized strategies for acute reperfusion will allow more acute stroke patients to benefit from thrombolytic therapy.

show abstract

“…In addition, to evaluate posterior circulation ischemia, protocols must be appropriately adjusted to include lower sections (Fig 7). 9 Nagahori et al 45 demonstrated prolonged time of bolus arrival and TTP in posterior circulation infarcts. CTP may be a potentially useful adjunct, particularly in the evaluation of posterior fossa ischemia because this location is notoriously difficult to evaluate on NCCT.…”

Section: Section Selectionmentioning

confidence: 99%

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

Lui¹,

Tang²,

Allmendinger³

et al. 2010

AJNR Am J Neuroradiol

120

View full text Add to dashboard Cite

SUMMARY: CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.ABBREVIATIONS: ACA ϭ anterior cerebral artery; AIF ϭ arterial input function; ASPECTS ϭ Alberta Stroke Program Early CT Score; CBF ϭ cerebral blood flow; CBV ϭ cerebral blood volume; CTA ϭ CT angiography; CTP ϭ CT perfusion; DWI ϭ diffusion-weighted imaging; ICA ϭ internal carotid artery; MCA ϭ middle cerebral artery; MTT ϭ mean transit time; NCCT ϭ noncontrast CT; PET ϭ positron-emission tomography; SPECT ϭ single-photon emission CT; TTP ϭ time to peak; VOF ϭ venous output function

show abstract

Supratentorial Dynamic Computed Tomography for the Diagnosis of Vertebrobasilar Ischemic Stroke

Cited by 13 publications

References 10 publications

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Brain perfusion-CT in acute stroke patients

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

Contact Info

Product

Resources

About