CT Perfusion (Stroke)

CT Perfusion

• Parameters
• Cerebral Blood flow
• Tmax
• Infarct
• Penumbra
• Tri-Health Example
• Syngo.via CT Neuro Perfusion
• Postischemic Hyperperfusion
• Seizure
• **********************************************
• Rapid CT perfusion article
• **********************************************

DEFUSE 3 TRIAL (mechanical thrombectomy)

• 6-16 hours
• DEFUSE 3 - Core < 70ml
• DEFUSE 3 - Mismatch ratio > 1.8
• DEFUSE 3 - Mismatch volume > 15 ml

DAWN TRIAL (mechanical thrombectomy)

• 6-24 hours
• Age 80+ -- Core < 20 ml
• Age <80 -- Core <30ml & NIHSS 10-20
• Age <80 -- Core <50ml & NIHSS > 20

Interpretaion

• **********************************************
• Check Gray matter (most metabolically active)
• Look at MTT and TTD for defects
• Check cortex for defects
• Next evaluate Deep gray nuclei
• Caudate
• Lentiform nucleus (Putamen and the Globus pallidus)
• Thalamus
• Check cerebellar cortex
• Next look at CBV and CBF
• Render Final expert interpretation!!

Dr. Millers Tutorial Videos

• Video 1
• Video 2
• Video 3

Stroke

• 2018 AHA/ASA Stroke Early Management Guidelines
• CVA Evolution
• Enhancing Infarct
• Hemorrhagic Transformation
• Infarct patterns
• Watershed Infarct

Territory's and patterns

• Axial vascular territorys
• Saggital vascular territorys
• Cerebellar vascular territorys
• Wallenberg syndrome

Vascular Anatomy

• Middle Cerebral Artery
• Anterior Cerebral Artery
• Posterior Cerebral Artery
• Basilar Artery
• Vertebral artery

Persistiant Fetal Anastomoses

• Carotid-basilar anastomoses
• Trigeminal artery
• Hypoglossal artery
• Proatlantal intersegmental artery
• Otic Artery