CT Perfusion Imaging in Acute Ischemic Stroke Management
Summary
Computed tomography perfusion (CTP) imaging has become integral to the rapid assessment and management of acute ischaemic stroke. By acquiring sequential contrast-enhanced CT images during the passage of contrast bolus, CTP quantifies haemodynamic parameters such as cerebral blood flow, cerebral blood volume and mean transit time. These parameters allow clinicians to distinguish irreversibly infarcted tissue (ischaemic core) from hypoperfused but salvageable tissue (penumbra). Automated post-processing platforms generate colour-coded maps and volumetric measurements that guide decision-making for intravenous thrombolysis and endovascular thrombectomy, often extending treatment windows beyond traditional time limits. In many centres, CTP has been incorporated into multimodal CT protocols alongside non-contrast CT and CT angiography, streamlining workflows and reducing door-to-needle and door-to-puncture times. Globally, the widespread availability of CT scanners and the rapid acquisition of perfusion data have democratized access to advanced stroke imaging, supporting treatment decisions in diverse healthcare settings. Ongoing refinements in acquisition techniques, contrast administration and deconvolution algorithms continue to improve image quality and reduce radiation dose, while research efforts aim to refine perfusion thresholds across patient subgroups, including those with small vessel disease or posterior circulation strokes.
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CT Perfusion Imaging in Acute Ischemic Stroke Management publication trend
The graph below shows the total number of articles in ct perfusion imaging in acute ischemic stroke management across all publications each year (not limited to Nature Index journals).
Technical terms
Cerebral blood flow (CBF): Volume of blood delivered to brain tissue per unit time, expressed in mL/100 g/min.
Cerebral blood volume (CBV): Volume of blood within a given amount of brain tissue, expressed in mL/100 g.
Mean transit time (MTT): Average time for blood to traverse the cerebral microvasculature, calculated as CBV divided by CBF.
Ischaemic core: Brain region with critically reduced perfusion and irreversible tissue injury.
Penumbra: Hypoperfused brain tissue at risk of infarction but potentially salvageable with timely reperfusion.
References
- Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: A systematic review of 27 trials. PLOS ONE (2017).
- CT Perfusion in Lacunar Stroke: A Systematic Review. Diagnostics (2023).
- Effectiveness of computed tomography perfusion imaging in stroke management. Frontiers in Neurology (2024).
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